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A New Methodology With Preliminary Clinical Evaluation

J. Stuart Nelson, MD; Thomas E. Milner, PhD; Bahman Anvari, PhD; B. Samuel Tanenbaum, PhD; Sol Kimel, PhD; Lars O. Svaasand, PhD; Steven L. Jacques, PhD

Arch Dermatol. 1995;131(6):695-700.

Abstract
Background and Design
The clinical objective in the treatment of a patient with port-wine stain (PWS) undergoing laser therapy is to maximize thermal damage to the PWS, while at the same time minimizing nonspecific injury to the normal overlying epidermis. With dynamic cooling, the epidermis can be cooled selectively. When a cryogen spurt is applied to the skin surface for an appropriately short period of time (on the order of tens of milliseconds), the cooling remains localized in the epidermis, while leaving the temperature of the deeper PWS vessels unchanged.

Results
Comparative measurements obtained by a fast infrared imaging detector demonstrated that the surface temperature prior to laser exposure could be reduced by as much as 40°C using the dynamic cooling technique. No skin surface textural changes were noted on PWS test sites cooled with a 20- to 80-millisecond cryogen spurt after flashlamp-pumped pulsed dye laser (FLPPDL) exposure (=585 nm; _p=450 microseconds) at the maximum light dosage possible (10 J/cm²). In contrast, epidermal necrosis occurred on the uncooled sites after such exposure. Six months after laser exposure, clinically significant blanching on the cooled sites indicates laser photothermolysis of PWS blood vessels did occur.

Conclusions
Our preliminary experiments demonstrate the feasibility of selectively cooling the normal overlying epidermis without affecting the temperature of the deeper PWS vessels. Furthermore, protection of the epidermis from thermal injury, produced by melanin light absorption at clinically relevant wavelengths, can be achieved effectively. An additional advantage of dynamic epidermal cooling is reduction of patient discomfort associated with FLPPDL therapy. Further studies are under way to determine an optimum strategy for applying this dynamic cooling technique during pulsed laser treatment of patients with PWS and others with selected dermatoses (dermal melanocytic lesions and tattoos).

(Arch Dermatol. 1995;131:695-700)

Author Affiliations
From the Beckman Laser Institute and Medical Clinic, Departments of Surgery and Dermatology, University of California, Irvine (Drs Nelson, Milner, and Anvari); Department of Engineering, Harvey Mudd College, Claremont, Calif (Dr Tanenbaum); Department of Chemistry, Technion—Israel Institute of Technology, Haifa (Dr Kimel); Division of Physical Electronics, University of Trondheim (Norway), Norwegian Institute of Technology (Dr Svaasand); and the Laser Biology Research Laboratory, University of Texas M. D. Anderson Cancer Center, Houston (Dr Jacques).

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