Research over the last 40 years has provided information on laser-tissue interactions and led to the development of many lasers used for a variety of dermatologic procedures. In this review, we discuss the current state of laser use in dermatology including the treatment of vascular lesions, tattoo removal, treatment of pigmented lesions, hair removal and laser skin resurfacing. In addition, we note several issues which need to be addressed in order to achieve an improved therapeutic outcome without adverse effects.

We determine experimentally the accuracy of pulsed photothermal radiometric (PPTR) temperature depth profiling in water-based samples. We use custom tissue phantoms composed of agar gel layers separated by very thin absorbing layers. Two configurations of the acquisition system are compared, one using the customary spectral band of the InSb radiation detector (3.0-5.5 microm) and the other with a spectrally narrowed acquisition band (4.5-5.5 microm). The laser-induced temperature depth profiles are reconstructed from measured radiometric signals using a custom minimization algorithm. The results correlate very well with phantom geometry as determined by optical coherence tomography (OCT) and histology in all evaluated samples. Determination of the absorbing layer depth shows good repeatability with spatial resolution decreasing with depth. Spectral filtering improves the accuracy and resolution, especially for shallow absorption layers (~120 microm) and more complex structures (e.g., with two absorbing layers). The average full width at half maximum (FWHM) of the temperature peaks equals 23% of the layer depth.

We report on development of an optical-thermal model to evaluate the use of pulsed photothermal radiometry (PPTR) for depth profiling of port wine stain (PWS) skin. In the model, digitized histology sections of a PWS biopsy were used as the input skin geometry. Laser induced temperature profiles were reconstructed from simulated PPTR signals by applying an iterative, non-negatively constrained conjugate gradient algorithm. Accuracy of the following PWS skin characteristics extracted from the reconstructed profiles was determined: (1) average epidermal thickness (z(epi)), (2) maximum epidermal temperature rise (DeltaT(epi,max)), (3) depth of PWS upper boundary (z(PWS)), and (4) depth of maximum PWS temperature rise (z(PWS,max)). Comparison of the actual and reconstructed profiles from PPTR data revealed a good match for all four PWS skin characteristics. Results of this study indicate that PPTR is a viable approach for depth profiling of PWS skin.

Background

The treatment of medium-sized (1.5-20 cm diameter) congenital melanocytic nevi (CMN) has been the concern of dermatologists for decades. Although many techniques have been described and utilized, no single treatment has emerged as applicable under all circumstances.

Methods

The Q-switched ruby laser (QSRL) at 694 nm, a wavelength well absorbed by melanin relative to other optically absorbing structures in skin, causes highly selective destruction of pigment-laden cells. In addition, the 20-nanosecond pulse duration produced by this laser approximates the thermal relaxation time for melanosomes, thereby confining the energy to the targeted cells.

Results

In the present report, treatment using the QSRL resulted in complete clinical removal of a biopsy-documented medium-sized compound CMN with no recurrence after 5 years. In contrast to other therapeutic modalities, complications such has hypertrophic scarring, dyspigmentation, or atrophy were not observed.

We introduce a multimodal facial color imaging modality that provides a conventional color image, parallel and cross-polarization color images, and a fluorescent color image. We characterize the imaging modality and describe the image analysis methods for objective evaluation of skin lesions. The parallel and cross-polarization color images are useful for the analysis of skin texture, pigmentation, and vascularity. The polarization image, which is derived from parallel and cross-polarization color images, provides morphological information of superficial skin lesions. The fluorescent color image is useful for the evaluation of skin chromophores excited by UV-A radiation. In order to demonstrate the validity of the new imaging modality in dermatology, sample images were obtained from subjects with various skin disorders and image analysis methods were applied for objective evaluation of those lesions. In conclusion, we are confident that the imaging modality and analysis methods should be useful tools to simultaneously evaluate various skin lesions in dermatology.

High speed video imaging and an inverse heat conduction problem algorithm were used to observe and measure the effect of the angle between the nozzle and surface of a skin phantom on: (a) surface temperature; (b) heat flux q; and (c) overall heat extraction Q during cryogen spray cooling (CSC). A skin phantom containing a fast-response temperature sensor was sprayed with 50 ms cryogen spurts from a commercial nozzle placed 30 mm from the surface. The nozzle was systematically positioned at angles ranging from 5 to 90 degrees (perpendicular) with respect to the phantom surface. It is shown that angles as low as 15 have an insignificant impact on the surface temperature, q and Q. Only exaggerated angles of 5 show up to 10% lower q and 30% lower Q with respect to the maximal values measured when nozzles are aimed perpendicularly. This study proves that the slight angle that many commercial nozzles have does not affect significantly the CSC efficiency.

We present a systematic experimental comparison of pulsed photothermal temperature profiling utilizing the customary spectral band of the InSb radiation detector (lambda=3.0 to 5.6 microm) and a narrowed acquisition band (4.5 to 5.6 microm). We use custom tissue phantoms composed of agar gel layers separated by thin absorbing layers. The laser-induced temperature profiles are reconstructed within the customary monochromatic approximation, using a custom minimization algorithm. In a detailed numerical simulation of the experimental procedure, we consider several acquisition spectral bands with the lower wavelength limit varied between 3.0 and 5.0 microm (imitating application of different long-pass filters). The simulated PPTR signals contain noise with amplitude and spectral characteristics consistent with our experimental system. Both experimental and numerical results indicate that spectral filtering reduces reconstruction error and broadening of temperature peaks, especially for shallower and more complex absorbing structures. For the simulated PPTR system and watery tissues, numerical results indicate an optimal lower wavelength limit of 3.8 to 4.2 microm.

A novel swept-laser-based Fourier-domain optical coherence tomography system using an electro-optic phase modulator was demonstrated. The imaging range was doubled by cancellation of the mirror image. The elimination of low-frequency noises resulting from dc and autocorrelation terms increased the sensitivity by 20 dB.