Dermatological Surgery – Update on Lasers


Lasers have been used for the treatment of cutaneous disorders for over 30 years. Technological advances have led to the availability of a wide range of devices that are powerful, versatile and cost-effective, enabling an increasing range of conditions to be treated safely and effectively. Lasers emit high intensity light of a single (monochromatic) wavelength, which is absorbed by target structures in the skin and converted to heat energy. This key principle underlies the interaction between light and biological tissues and is known as the theory of selective photothermolysis. The main targets (chromophores) in the skin are oxyhaemoglobin, contained in blood, and melanin, contained in hair follicles and pigmented lesions. Other targets include tissue water and tattoo pigments. Selective heating of target structures produces clinically appreciable effects, while heating of non-target structure leads to unwanted side effects.

Intense pulsed light (IPL) devices are, like lasers, sources of high-energy light. However, IPLs are polychromatic and emit multiple wavelengths with each pulse. Filters with different cut off values tailor the wavelength range that is emitted to the cutaneous target of interest.

Q Switching of lasers produces extremely high powered beams in nanosecond pulses which produce photoacoustic damage to tattoo particles and melanosomes.

Significant advances in the use of lasers for skin disorders will be discussed. New generation pulsed dye lasers and dual wavelength lasers have optimized the treatment of vascular lesions such as port wine stains. The improved safety of lasers for hair removal has enabled treatment to be carried out on dark skinned individuals. Pneumatic suction devices may improve comfort and efficacy of treatment and are available as an attachment for existing lasers or integrated into handpieces. Fractional resurfacing technology has bridged the gap between ablative resurfacing lasers and non-ablative lasers and is currently the most exciting new development in this field.

REFERENCES

1: Lanigan S. Reduction of pain in the treatment of vascular lesions with a pulsed dye laser and pneumatic skin flattening. Lasers Med Sci. 2009: 24(4):617-20.

2: Lanigan SW, Taibjee SM. Recent advances in laser treatment of port-wine stains. Br J Dermatol. 2004;151(3):527-33.

3: Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426-38.



Source by Dr Sean Lanigan