article on cooling devices
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Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser. On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice.
Cooling can be achieved before, during or after laser treatment, referred to as pre-cooling, parallel cooling and post-cooling, respectively. On the basis of methods, cooling is of two types: contact cooling and non-contact cooling. Contact cooling can be achieved by active (copper, sapphire tips) or passive (ice or cold gels) methods. In contact cooling, tissue cooling is achieved by conduction of heat from the skin to the cooling device or substance placed directly onto the skin. In passive contact cooling, the device removes heat from the surface of the skin by energy transfer from the warm skin surface to a cold cooling agent by heating up the agent. However, in active contact cooling, the heat transposed to the device is actively removed by thermoelectric elements or flowing liquid cooling agents. In non-contact cooling, heat is actively removed from tissues through either evaporation or convection. Non-contact cooling can be achieved using cryogen spray or cold air.
The primary objective of laser therapy for patients with specific dermatoses is to maximise thermal damage to the target chromophores while minimising injury to the normal skin. However, in some cases, the threshold dose of incident laser beam for epidermal injury can be very close to the threshold for removal of the chromophore, thus questioning the administration of high doses. Dark-skinned patients are more susceptible to these problems on account of their increased epidermal melanin which competes as a significant chromophore for laser energy, leading to increased rate of pain, blistering, scarring and dyspigmentation. A method of dealing with this problem is to selectively cool the most superficial layers of the skin. It should be remembered that absorption of energy by melanin may lead to production of heat, but subsequent cooling of the epidermis shall prevent the elevation of temperature beyond the threshold temperature responsible for thermal injury.
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Cooling can be achieved before, during or after laser treatment, referred to as pre-cooling, parallel cooling and post-cooling, respectively. On the basis of methods, cooling is of two types: contact cooling and non-contact cooling. Contact cooling can be achieved by active (copper, sapphire tips) or passive (ice or cold gels) methods. In contact cooling, tissue cooling is achieved by conduction of heat from the skin to the cooling device or substance placed directly onto the skin. In passive contact cooling, the device removes heat from the surface of the skin by energy transfer from the warm skin surface to a cold cooling agent by heating up the agent. However, in active contact cooling, the heat transposed to the device is actively removed by thermoelectric elements or flowing liquid cooling agents. In non-contact cooling, heat is actively removed from tissues through either evaporation or convection. Non-contact cooling can be achieved using cryogen spray or cold air.
The primary objective of laser therapy for patients with specific dermatoses is to maximise thermal damage to the target chromophores while minimising injury to the normal skin. However, in some cases, the threshold dose of incident laser beam for epidermal injury can be very close to the threshold for removal of the chromophore, thus questioning the administration of high doses. Dark-skinned patients are more susceptible to these problems on account of their increased epidermal melanin which competes as a significant chromophore for laser energy, leading to increased rate of pain, blistering, scarring and dyspigmentation. A method of dealing with this problem is to selectively cool the most superficial layers of the skin. It should be remembered that absorption of energy by melanin may lead to production of heat, but subsequent cooling of the epidermis shall prevent the elevation of temperature beyond the threshold temperature responsible for thermal injury.
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