The eradication of Trichophyton rubrum has been attempted via laser irradiation because it could result advantageous relative to current clinical therapies. Anticipating that the necessary thermal effects could unintentionally damage the underlying toe dermal layer, we have explored two auxiliary approaches: (a) laser irradiation under vacuum pressure, with and without water dousing and, (b) cooling followed by laser heating (thermal shock). The rationale is that at low pressures, the temperature necessary to achieve water evaporation/boiling is significantly reduced, thus requiring lower fluences. Similarly, a thermal shock induced by cooling followed by laser irradiation may require lower fluences to
achieve fungus necrosis. For all experiments presented we use a Cooltouch, model CT3 plus, 1320 nm laser to irradiate fungi colonies. The vacuum pressure experiments exposed fungi colonies to a subatmospheric pressure of 84.7 kPa (25 inHg) with and without water dousing for 5 min, followed by irradiation with 4.0 J/cm2 fluence and 40-90 J total energies. The thermal shock experiments consisted of three sections at 4.8 J/cm2: cooling the fungus to 0 °C at 0.39 °C/min and then irradiating to 45-60 °C; cooling to -20 °C at 1.075 °C/min and irradiating to 45 °C; and cooling to -20 °C at 21.5 °C/min and irradiating to 45 °C. Fungus growth rate over a 1-week period assessed the feasibility of these procedures. Results indicated both approaches hamper the growth rate of fungi colonies relative to untreated control samples, especially water dousing under vacuum conditions and slow cooling rate preceding irradiation for thermal shock effect.
We present our research into a pulsed xenon lamp source for the treatment of psoriasis and other skin disorders. Various filtering techniques, lamp configurations, power supply configurations and delivery systems are discussed. Comparisons are made to existing treatment modalities. Cryogen cooling of the treatment site is discussed.
The purpose of this study is to evaluate the safety and effectiveness of the New Star Model 130 neodymium:yttrium aluminum garnet (Nd:YAG) laser system for nonablative laser treatment of facial rhytides (e.g., periorbital wrinkles). Facial rhytides are treated with 1.32 micrometer wavelength laser light delivered through a fiberoptic handpiece into a 5 mm diameter spot using three 300 microsecond duration pulses at 100 Hz pulse repetition frequency and pulse radiant exposures extending up to 12 J/cm2. Dynamic cooling is used to cool the epidermis selectively prior to laser treatment; animal histology experiments confirm that dynamic cooling combined with nonablative laser heating protects the epidermis and selectively injures the dermis. In the human clinical study, immediately post-treatment, treated sites exhibit mild erythema and, in a few cases, edema or small blisters. There are no long-term complications such as marked dyspigmentation and persistent erythema that are commonly observed following ablative laser skin resurfacing. Preliminary results indicate that the severity of facial rhytides has been reduced, but long-term follow-up examinations are needed to quantify the reduction. The mechanism of action of this nonablative laser treatment modality may involve dermal wound healing that leads to long- term synthesis of new collagen and extracellular matrix material.
Nonablative skin resurfacing is a dermatologic procedure utilizing pulsed laser irradiation and dynamic cooling to induce selectively a wound healing response in the papillary and upper reticular dermis. Using temperature measurements of human skin provided by pulsed photothermal radiometry immediately following laser irradiation (lambda equals 1.32 micrometer), spatial distribution of thermal damage is predicted in response to various potential therapeutic laser- cryogen doses. Results of our analysis suggest that appropriate application of pulsed laser irradiation and cryogen spray cooling may be used to protect the epidermis and selectively confine thermal injury to the papillary and upper reticular dermis. Development of nonablative skin resurfacing will require understanding the relationship between the degree of dermal photocoagulation and the cutaneous wound healing response following laser irradiation.
The THC:YAG laser was used to create 93 thermal sclerostomies ab externo in 81 glaucomatous eyes of 76 patients. This holmium laser is a long-pulsed, compact, self-contained, solid-state laser operating in the near infrared. A 1-mm conjunctival stab incision was made 5-15 mm from the sclerostomy site to allow entry of a specially designed 22-gauge optic probe that delivers energy at a right angle to the long axis of the fiber. Pulse energies of 80 mJ to 120 mJ were used with a repetition rate of 5 pulses per second. Total energy levels to produce full-thickness sclerostomies ranged from 1.4 to 7.2 J. Seventy-eight eyes received the antimetabolite 5-fluorouracil. Success was defined as postoperative intraocular pressure <22 mmHg, or a >30% reduction in intraocular pressure if preoperative pressure was <22 mmHg. Estimated probability of success was 0.66 at 12 months and 0.57 at both 24 months and 30 months. Mean intraocular pressure of successful cases was 12.7 mmHg, 12.9 mmHg, and 13.0 mmHg at 12, 24, and 30 months, respectively. This is the 30-month report of an on-going clinical trial.