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Keyvan Nouri - Handbook of Lasers in Dermatology

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Keyvan Nouri Handbook of Lasers in Dermatology
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This book discusses lasers and light technologies in dermatology. The innovation is due to the book format: a handbook. It is the first handbook of lasers in dermatology, facilitating access to information to all individuals interested in lasers in this specific medical field . The most recent lasers devices and its applications will be discussed. Illustrations and tables will make the book didactic and comprehensive. Lasers in dermatology are a constantly evolving field. Over the past few decades, novel devices have been developed and new indications for their use have emerged. A broad understanding of the relationship between science and laser principles is the foundation of a solid dermatologic practice. The Lasers in Dermatology Handbook is a tool to understand the use of lasers in clinical practice. Important topics such as vascular lesions, warts, acne, scars, and pigmented lesions are presented and discussed in all aspects. The wide spectrum of laser and light technologies available for skin resurfacing and rejuvenation will be covered as well. Written by internationally renowned authors, this handbook serves as a cornerstone for laser applications and provides updated information for all physicians, particularly dermatologists, interested in implementing lasers in their practice.

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Springer-Verlag London 2014
Keyvan Nouri (ed.) Handbook of Lasers in Dermatology 10.1007/978-1-4471-5322-1_1
1. Basic Principles of Lasers: Interactions Between Lasers and Tissue
Salma Pothiawala 1
(1)
Department of Dermatology and Cutaneous Surgery, University of South Florida, 13330 USF Laurel Drive, Tampa, FL 33612, USA
(2)
Department of Dermatology, Laser and Skin Surgery Center of Northern California, University of California Davis, School of Medicine, 3835J Street, Sacramento, CA 95816, USA
(3)
Wellman Center for Photomedicine, Massachusetts General Hospital, 999 Summer Street, Suite 205, Stamford, CT 06905, USA
(4)
Connecticut Skin Institute, 999 Summer Street, Suite 205, Stamford, CT 06905, USA
Salma Pothiawala
Email:
Suzanne L. Kilmer
Email:
Omar A. Ibrahimi (Corresponding author)
Email:
Abstract
Lasers have become extremely important treatment devices in the field of dermatology. They have a variety of applications, ranging from the treatment of vitiligo, cutaneous T-cell lymphoma, hair removal, and skin resurfacing, among others. It is therefore fundamental for the clinician to have an understanding of laser-tissue interactions.
Keywords
Dermatology Lasers Physical properties Tissues Thermal properties Optical properties
Introduction
  • Lasers have become extremely important treatment devices in the field of dermatology. They have a variety of applications, ranging from the treatment of vitiligo, cutaneous T-cell lymphoma, hair removal, and skin resurfacing, among others. It is therefore fundamental for the clinician to have an understanding of laser-tissue interactions.
Spontaneous and Stimulated Emission
  • LASER is an acronym for l ight a mplification by s timulated e mission of r adiation [].
  • Spontaneous emission is the process by which an excited atom spontaneously emits a photon. Electrons go from excited to a resting state when a photon of energy is released [].
  • A laser contains a laser chamber, a lasing medium (solid, liquid, or gas) and an external source of energy. Stimulated emission occurs when the external source of energy causes electrons to be excited in the lasing medium. A cascade reaction is generated when these excited electrons release photons, which then collide with other excited electrons in the lasing medium and cause a release of many identical photons at the same time. Laser light continues to be generated as long as the above cascade perpetuates [].
Laser Light Properties
  • Laser light has several unique properties including monochromicity, coherence, and collimation [].
Monochromacity
  • As opposed to light from the sun, laser light is monochromatic and emits a well-defined wavelength of light (Table ].
  • In terms of clinical significance, this monochromatic property of laser light allows it to target specific chromophores, such as water, hemoglobin, and melanin, and allows for specific clinical applications [].
Coherence
  • Laser beams are both temporally and spatially coherent, and akin to a column of soldiers marching in step [].
Collimation
  • Laser beams are parallel to each other, and therefore exhibit collimation. A collimated beam is created in the laser chamber when light is reflected between two mirrors and only the exit of parallel waves is allowed [].
  • In practice, a lens on a laser focuses the parallel light beam down to the smallest possible spot size, or the diffraction-limited spot, to allow the light to focus on the clinical target [].
Radiometry
  • The four main concepts in understanding laser light and skin interactions are energy, power, fluence, and irradiance [].
  • The amount of light emitted from a laser can be quantified by both energy and power. Energy represents work (measured in joules), while power (measured in watts or joules per second) is the rate at which energy is expended [].
  • The intensity of the laser beam on the skin is a function of the area of skin over which it is spread (i.e., the spot size) [].
    • Spot size=cross-sectional area of laser beam
  • Fluence (measured in joules per square centimeter) is the energy density of a laser beam.
  • Fluence=wattsseconds/cm2=joules/cm2=laser outputpulse duration/spot size
  • Irradiance (measured in watts per square centimeter) refers to the power density of a continuous wave laser beam, and it is inversely proportional to the square root of the radius of the spot size [].
    • Irradiance=watts/cm2=laser output/spot size
  • Exposure time, fluence, and irradiance of a laser can be altered depending on the particular clinical use desired by the clinician [].
Table 1.1
Lasers used in dermatology []
Laser wavelength (nm)
Chromophore
Excimer 308
DNA/RNA
KTP 532
Hemoglobin
Pulsed dye 585595
Hemoglobin
Q-switched ruby 694
Blue, black tattoo pigment
Long-pulsed ruby 694
Melanin
Q-switched Alexandrite 755
Blue, black, green tattoo pigment
Long-pulsed Alexandrite 755
Melanin
Diode 810
Melanin
Q-switched Nd:YAG 1,064
Tattoo pigment
Long-pulsed Nd:YAG 1,064
Melanin
Long-pulsed Nd:YAG 1,320
Water
Diode 1,450
Water
Er:glass 1,540
Water
Er:YAG 2,940
Water
Carbon dioxide 10,600
Water
Tissue Interactions
Skin Optics
  • Laser interacts with skin in four possible ways: reflection, absorption, scattering, or transmission [].
  • Transmission is the passage of light through a tissue without altering either the tissue or the light itself [].
  • Reflection occurs when light bounces off the surface of this tissue without entry into tissue. Four percent to seven percent of light is reflected off the skin secondary to the difference in the refractive index between stratum corneum and air [].
  • Scattering refers to the fragmentation of light after it has entered the skin, and it results from the interaction of light with varied elements that makeup tissue. It mainly results from interaction of light with dermal collagen [].
  • Effects on tissue are only achieved if light is absorbed as this results in the release of photons [].
Thermal Interactions and Selective Photothermolysis
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