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The epidermal melanin content affects most dermatologic treatments involving light, and can limit the therapeutic success significantly. Therefore, knowledge of the optical properties of skin is required. This study investigates how the concentration of melanin influences visible reflectance spectra of skin and the relationship to threshold radiant energy fluence for melanosomal or melanocyte destruction. Reflectance spectra were measured at 28 pigmented human skin sites in vivo. For Asian and Caucasian subjects, measured reflectance values varied over the same range, while significantly lower values were recorded for African individuals. Epidermal melanin absorption coefficients measured at 694 nm were about 2500 m-1 for African, and 300–1200 m-16 for Caucasian and Asian skin. Twenty-five skin sites were exposed to ruby laser pulses (694 nm), where the pulse duration was long enough to allow heat diffusion between melanosomes. Hypopigmentation occurred, on average, at 12 and 26 J cm-2 for sun-exposed and sun-protected white skin, respectively, while slightly lower threshold values resulted from the measured spectra. As visible reflectance spectra reveal information regarding skin pigmentation and individual threshold doses for melanosomal damage, a use as a diagnostic tool in various dermatological laser treatments is apparent.

Photodynamic therapy (PDT) based on topical application of photosensitizers is currently in clinical use for the treatment of basal cell carcinoma of the skin, and it has been evaluated in animal models for photo-ablation of the endometrium. This paper presents a dosimetry model which indicates that a limiting factor in treating thick tumours will be the transport of the drug into the tumour rather than depletion of the optical distribution. The model predicts that an optical irradiation of 100 mW cm−2 at 635 nm for 20 min, ie well below the threshold for hyperthermic reaction, will give an adequate light dose to a depth of 3 mm. The time required for photosensitizers to diffuse to this depth is in the range of 3–15 h, dependent on the diffusion properties of the tissue.

Monte Carlo simulation of laser energy deposition in a port-wine stain (PWS) skin model and numerical solution of the thermal diffusion equation have been used to calculate threshold energies for thermal injury of PWS blood vessels for different vessel sizes and laser pulse durations. It has been assumed that an average vessel temperature rise of 65 ‡C causes thermal injury to the blood vessel. The result is that for a certain combination of wavelength, pulse duration and incident energy density, only a limited range of blood vessel sizes can be injured optimally. Higher energy densities are required to injure smaller vessels with the same pulse duration, spot size and wavelength. This gives support to the mechanisms of selective photothermolysis suggested previously by Anderson and Parrish, although their model was based on the cooling behaviour of instantaneously heated vessels. The authors hypothesize that different laser parameter settings that match the individual PWS vessel anatomy during treatment will be used in the future, instead of many treatments with the same laser parameters. This could lead to less treatment sessions and to an improved predictability of clinical results.

Selective photothermolysis with pulsed lasers is presumably the most successful therapy for port-wine stain birthmarks (flammeus nevi). Selectivity is obtained by using an optical wavelength corresponding to high absorption in blood, together with small absorption in tissues. Further on, the pulse length is selected to be long enough to allow heat to diffuse into the vessel wall, but simultaneously short enough to prevent thermal damage to perivascular tissues. The optical wavelength and pulse length are therefore dependent on vessel diameter, vessel wall thickness and depth in dermis. The present work demonstrates that in the case of a 0.45 ms long pulse at 585 nm wavelength, vessels of 40–60Μm require minimum optical fluence. Smaller vessels require higher fluence because the amount of heat needed to heat the wall becomes a substantial fraction of the absorbed optical energy. Larger vessels also require a higher dose because the attenuation of light in blood prevents the blood in the centre of the lumen from participating in the heating process. It is shown that the commonly used optical dose in the range of 6–7 J cm−2 is expected to inflict vessel rupture rather than thermolysis in superficially located vessels. The present analysis might serve to draw guidelines for a protocol where the optical energy, wavelength and pulse length are optimized with respect to vessel diameter and depth in dermis.

The clinical objective in laser treatment of port-wine stains (PWS) is to induce selective photothermolysis of subsurface blood vessels without damaging the overlying epidermis. This paper investigates the effectiveness of ‘dynamic’ cooling, where a cryogen is sprayed on the skin surface for an appropriately short period of time, to eliminate epidermal thermal injury during laser treatment of PWS. Comparative measurements of radiometric surface temperature from cooled and uncooled laser irradiated (585 nm) PWS sites, and theoretical predictions of temperature distributions within skin in response to dynamic cooling in conjunction with laser irradiation are presented. Rapid reduction of skin surface temperature and localization of cooling the epidermis are obtained when a cryogen is sprayed on skin prior to laser irradiation. Successful blanching of the PWS without thermal injury to the overlying epidermis is accomplished.

Port-wine stain is a congenital birthmark consisting of an abnormal density of blood vessels in the upper dermis. The enlarged blood volume gives the lesion a red to purple colour. The aim of the treatments is to destroy the vessels to the extent necessary for obtaining a normal skin coloration. Thus, in principle, all relevant information about the lesion should be contained in a reflectance spectrum in the visible. However, the relation between the reflectance spectrum and tissue parameters such as scattering, melanin content and blood distribution is somewhat composite. This work tries to enlighten this relation in terms of a very simple analytical mathematical model, and it is demonstrated that such a model at least will contribute to a qualitative understanding of the relevance of the various parameters.

The relationship between photothermal damage to blood vessels of diameter,d, and laser pulse duration,t p, was verified in a series of studies using the chick chorioallantoic membrane (CAM). A total of 879 individual CAM blood vessels (d=50–130μm) was irradiated, using a laser pulse duration of 0.45 or 10 ms. Laser-induced vascular damage was observed in real time, recorded on videotape, and evaluated in a double-blind fashion. Permanent damage was confirmed by inspection 24 h after laser exposure. Under the conditions of this experiment, only when laser pulse durations are approximately equal to the estimated thermal relaxation times (τ) of the CAM microvessels can the critical core intravascular temperature, necessary to destroy vessels irreversibly, be achieved and sustained for sufficient time. Shorter pulse durations are more effective for damaging smaller blood vessels; conversely, longer pulse durations are more effective for damaging larger diameter vessels.

The rationale of hyperthermic treatment of tumours is based on the phenomenon that several tumours have a reduced tolerance for exposure to temperatures in the region 42–47 °C for 20–30 min. Hyperthermia may also be used as an adjunct to other modalities such as chemotherapy, conventional radiation therapy or photodynamic therapy.

The basic principles for the temperature rise in laser irradiated blood perfused tissues are discussed. The dicussion emphasises the conditions which are relevant for selective hyperthermic treatment of malignant tumors. The temperature rise is, under these circumstances, well below the threshold temperature for coagulation and denaturation of proteins.