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10/02/2013
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Peter Bjerring, MD, PhD
Medical Director and Head of The Laser Centre, Mølholm Hospital, Denmark Consultant, ZBC Multicare, Hilversum, Netherlands
Professor, Faculty of Medicine, University of Swansea, Wales, UK Past President of the European Society for Lasers in Dermatology (ESLD)
This work was not supported by any direct or non direct funding. It is under the author’s own responsibility
DR Peter Bjerring
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¨ Many laser- and intense pulsed light (IPL) manufacturers have now developed low-power systems
¨ The technology is based on experience and knowledge from the professional device market
¨ The most popular indications for optical home treatments are:
¡ Hair removal - or hair management ¡ Skin rejuvenation (fine wrinkles, pigment treatment) ¡ Acne treatment ¡ Pigment reduction
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¡ Hair removal or hair management Visible light
¡ Skin rejuvenation (fine wrinkle treatment) Visible and IR light
¡ Pigment disorders Visible light
¡ Acne treatment – Blue and red light
¡ Vitiligo – UV-B
¡ Psoriasis – UV-B
¡ Eczema – UVB/UVA
¡ Seasonal Affected Disorder Visible light
¡ Rosacea Visible light
¡ Hypovitaminosis D UV-B
¡ Hair removal or hair management Visible light
¡ Skin rejuvenation (fine wrinkle treatment) Visible and IR light ¡ Pigment disorders Visible light
¡ Acne treatment – Blue and red light
¡ Vitiligo – UV-B
¡ Psoriasis – UV-B
¡ Eczema – UVB/UVA
¡ Seasonal Affected Disorder Visible light
¡ Rosacea Visible light
¡ Hypovitaminosis D UV-B
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¨ IPL based systems ¡ Typical maximum IPL pulse energy 7.5 - 30 J ¡ Pulse duration 2.5 - 60 ms ¡ Wavelengths 450-1200 nm
¨ Laser based systems ¡ Typical maximum laser pulse energy 22 J/cm2 ¡ Pulse durations up to 600 ms ¡ Wavelength 800-810 nm and 1400-1450 nm
¨ Fluorescence lamp based systems ¡ Narrow band UV-B lamps – 311nm ¡ White light
¨ LED based systems ¡ 632 nm ¡ 417 nm
Optical characteristics of home-use devices
¨ IPL based systems ¡ Typical maximum IPL pulse energy 7.5 - 30 J ¡ Pulse duration 2.5 - 60 ms ¡ Wavelengths 450-1200 nm
¨ Laser based systems ¡ Typical maximum laser pulse energy 22 J/cm2 ¡ Pulse durations up to 600 ms ¡ Wavelength 800-810 nm and 1400-1450 nm
¨ Fluorescence lamp based systems ¡ Narrow band UV-B lamps – 311nm ¡ White light
¨ LED based systems ¡ 632 nm ¡ 417 nm
A closer look on the laser-based home-use devices
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Philips ReAura diode laser 1435 nm fractional home-treatment device
Palomar Palovia diode laser 1420 nm fractional home-treatment device
From: Palovia product presentation
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From Palovia product presentation
Intenzity Innovation Inc.
Investigational device (not FDA approved)
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¨ Wavelength: 1425 nm ¨ Power: 900 mW ¨ Spot size at skin surface: 100µm ¨ Coverage per scan: 5% of skin surface
¨ Power density at skin surface: 10kW/cm2 ¡ Fluence: 50J/cm2 at 5mJ/pulse ¡ Fluence: 70J/cm2 at 7mJ/pulse
• Spots are separated
• Each radiated zone is independent limi3ng thermal diffusion
• Tissue necrosis is induced -‐ while other than the target areas are substan3ally unaffected
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¨ Study design: ¡ randomized, double-blinded, prospective ¡ objective ultrasonographical measurements
¨ 13 Volunteers ¡ Age 21 - 84 years, (avg. 53,2 years, SD: 17.9 years)
¨ 3 treatments, 1 week intervals
¨ Follow-up 1 month after last treatment
¨ Split face study randomized treatment ¡ 5 mJ/spot (one side of face) ¡ 7 mJ/spot (other side of face)
¨
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¨ DermaScan (Cortex Technology, Denmark) ¡ 20 MHz high frequency ultrasound
¨ Measurements: ¡ Skin ultrasonographic density (a measure of collagen content)
¡ Skin thickness
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Before after skin rejuvenation
5mJ treatment
15,0020,0025,0030,0035,0040,0045,0050,0055,00
Before After
Den
sity
in a
.u.
7mJ treatment
15,0020,0025,0030,0035,0040,0045,0050,0055,00
Before After
Den
sity
in a
.u.
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¨ Dermal density
Ø Relative increase compared with before: 42.8% (SD: 29.1%)
Ø The improvement is statistically significant, p=4.2 x 10-5
¨ Dermal density
Ø Relative increase compared to before: 41.2% (SD: 26.2%)
Ø The increase is statistically significant: p=5.5 x 10-6
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Lee WR, Shen SC, Kuo-Hsien W, Hu CH, Fang JY. J Invest Dermatol. 2003 Nov;121(5):1118-25.
Lasers and microdermabrasion enhance and control topical delivery of vitamin C
RESULTS: The Er:YAG laser showed the greatest enhancement of skin permeation of vitamin C The CO2 laser at a lower fluence promoted vitamin C permeation with no ablation of the stratum corneum or epidermal layers
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Fang JY, Lee WR, Shen SC, Fang YP, Hu CH. Br J Dermatol. 2004 Jul;151(1):132-40
Enhancement of topical 5-aminolaevulinic acid delivery by erbium:YAG laser and microdermabrasion RESULTS: The Er:YAG laser showed the greatest enhancement of ALA permeation, producing enhancement ratios from 4-fold to 246-fold relative to the control
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¨ Normal skin, ventral side of both upper arms
¨ One side treated with non-ablative fractional 1425 nm diode laser designed for home treatment
¨ Symmetrical areas incubated with 5-ALA 0.5%
Intenzity Innovation , Inc.
Investigational device (not FDA approved)
10/02/2013
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¨ Wavelength: 1425 nm ¨ Power: 900 mW ¨ Spot size at skin surface: 100µm ¨ Coverage per scan: 5% of skin surface
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¨ Non- treated side: ¡ 10.4% increase of
fluorescence
¨ Micro-spot treated side: ¡ 24.5% increase of
fluorescence
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Effect of local controlled heat on transdermal delivery of nicotine Petersen KK, Rousing ML, Jensen C, Arendt- Nielsen L, Gazerani P Int J Physiol Pathophysiol Pharmacol 2011, 30; 3(3): 236–242.
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¨ Home treatment fractional diode lasers are effective for peri-ocular skin rejuvenation
¨ Even non-ablative fractional laser treatment increases the uptake of topical drugs
¨ Simple, local skin heating may account for the increased uptake of topical products
¨ Further studies are needed to optimize home treatment laser parameters for enhanced delivery of topical drugs and cosmetics
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Peter Bjerring, MD, PhD
Medical Director and Head of The Laser Centre, Mølholm Hospital, Denmark Consultant, ZBC Multicare, Hilversum, Netherlands
Professor, Faculty of Medicine, University of Swansea, Wales, UK Past President of the European Society for Lasers in Dermatology (ESLD)
