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Lasers: Basic Principle and Uses in Dermatology: DR Rohit Kr. Singh Res. (Dermatology) Base Hospital LKO
Lasers: Basic Principle and Uses in Dermatology: DR Rohit Kr. Singh Res. (Dermatology) Base Hospital LKO
USES IN DERMATOLOGY
Dr Rohit Kr. Singh
Res. (Dermatology)
Base Hospital
LKO
Contents
• Introduction
• History of lasers
• Basics components of laser
• Principle and working of laser
• Effect of laser on skin tissue
• Applications of laser principles
• Laser hazards and protections
Introduction
DEFINITION
• Light Amplification by the Stimulated Emission of Radiation
(acronym coined by Gordon Gould)
Conceptualization
A fantasy well-established in the past
The “fiery ray” described by H.G. Wells is the incarnation of the absolute weapon: fired out of
a vibrating funnel, a narrow ray straight as a rod sweeps over the surrounding countryside
destroying everything in its path. It is hardly surprising that this fantasy of ultimate power (a
“death ray” that quickly and “cleanly” kills the potential target from afar) was extremely
popular during the first half of the 20th century and when the research scientist T.
History : Some important dates
• Technically, the whole device is known as a LASER OSCILLATOR, but this term is often shortened to simply
“laser”.
Principle of laser
• Atom will absorb and
emit light photons at hc
particular wavelength E hf
corresponding to the
energy differences
between orbits. The
wavelength l of
emitted or absorbed
photon can be
obtained by the
formula
• where E is the
change in energy
between the initial
and final orbits.
Principle of laser (cont...)
• Two energy levels E1 and E2 (E1 < E2) whose atoms can
interact with light of frequency
• The group E1-E2 is called radiative transition if atoms can
only pass from E1 to E2 (or from E2 to E1 ) by interacting with
light
• E1 is called the lower energy level
• E2the upper energy level
The emission-absorption principle
• Absorption:
– An atom in a lower level absorbs a photon of frequency hν and moves to an upper level
• Spontaneous emission
– An atom in an upper level can decay spontaneously to the lower level and emit a photon of
frequency hν if the transition between E2 and E1 is radiative
– This photon has a random direction and phase
• Stimulated emission
– An incident photon causes an upper level atom to decay, emitting a “stimulated” photon
whose properties are identical to those of the incident photon
– The term “stimulated” underlines the fact that this kind of radiation only occurs if an incident
photon is present
– The amplification arises due to the similarities between the incident and emitted photons
Population inversion and pumping
• To favour stimulated emission over
absorption, there need to be more •If there are more atoms in the upper
excited-state atoms than ground-
state atoms level (N2) than in the lower level (N1),
the system is not at equilibrium
• Spontaneous emission naturally tends
to empty the upper level so this level •A situation not at equilibrium must be
has to be emptied faster by
stimulated emission created by adding energy via a process
known as “pumping” light in order to
• It has been proved that stimulated raise enough atoms to the upper level
emission is much more likely to
happen if the medium used is flooded
with light (i.e. with a large number of •This is known as population
photons) inversion and is given by N2 - N1 = Δ
+ •Light is amplified when the population
inversion is positive
• A good way to do this is to confine
the photons in an optical cavity
•Pumping may be electrical, optical or
• The confinement of the light chemical
increases the probability of
stimulated emission rather than
spontaneous emission occurring
Spectroscopic systems used to create
a laser
• Every pumping system (particularly optical
or electrical) corresponds to a certain
energy, which must be transferable to the
atoms of the medium
An optical cavity selects a specific beam (a Gaussian beam) from the many
photons spontaneously emitted by the “lamp-amplifying medium” and the
number of photons carried by this beam is increased considerably, as it travels
back and forth, by the process of stimulated emission. This beam can have a
very low divergence and can be very precisely focused if the right optical tools
are used.
Monochromaticity
• The spectral bandwidth of a laser is given by the
width of the spontaneous emission: if the
transition between the upper and lower levels is
narrow, then the spontaneous emission will be
fractions of a nanometre (this is the case for the
red line in neon, which has a width equal to
1/1000th of a nanometre and a frequency of 1
GHz)
Monochromicity
LASER characteristics
Wavelenght lambda nm
•Same pump source: •Dye lasers use organic •Solid state lasers
electricity materials that are either
generally emit in the semiconductor (or
•The gaseous species visible spectrum and diode) lasers
enter the excited state are thus coloured pumped electrically
either directly, by or those with a
collision with electrons, •The pump source of crystalline or glass
or indirectly, by collision dye lasers is optical: matrix pumped
with other gases, either an arc lamp or, optically
themselves electrically in the majority of
excited cases, another laser •Also have range in
(gas or solid state) visible and
•Gas lasers cover the ultraviolet spectrum
whole optical spectrum, •Dye lasers are the
from the ultraviolet to only ones to cover the
the far infrared visible spectrum
entirely
Excimer Non – Laser light
lasers sources
• Name is derived from the Intense pulse light
terms excited and dimers
Non – coherent light
• Use reactive gases, chlorine within 500 to 1200 nm
and fluorine mied with inert
gases such as argon,
krypton,, or xenon
• Melanin absorbs broadly across the visible and ultraviolet (UV) spectrum
• Oxyhemoglobin and reduced hemoglobin in blood exhibit strong bands in the UV, blue,
green and yellow regions
• Water has strong absorption in the infrared (IR) region
“Effect Of Laser On Skin Tissue”
Skin optics
Fresnel reflectance : 4–7% of
light is typically reflected
because of the difference in
the refractive index between
air (n = 0) and stratum
corneum (n = 1.45)
Penetration of lasers
• In pigmented epidermis, melanin Penetration of laser depends
absorption - optical spectrum (200– upon
1000 nm) 1. Absorption and scattering
2. Dept of penetration increases
• In the dermis, there is strong, with wavelength
wavelength-dependent scattering by 3. Amount of scattering is
collagen fibres
inversely proportional to
• In general, between 280 and 1300 wavelength
nm, the depth of penetration
increases with wavelength
Photo-vaporization
• With very high power densities,
instead of cooking, lasers will
quickly heat the tissues to above
100o C , water within the tissues
boils and evaporates. Since 70%
of the body tissue is water, the
boiling change the tissue into a
gas
Thermal relaxation time (TRT)
• Thermal relaxation time (TRT) is defined, for a given tissue
structure, as the time required for the heated tissue to cool
halfway towards its initial temperature
• Complications
– Purpura is the result of microvascular hemorrhage,
– Subsequent thrombosis
– Delayed appearance of vasculitis
Hemangiomas PDL
• Mechanism
– Treatment of tattoos with Q-switched lasers fragments the ink particles and
selectively kills pigment-containing cells, with
– Resultant ink particle release
– Subsequent removal of tattoo ink particles can occur via an epidermal crust
and/or lymphatic transport, and some particles are re-phagocytosed by
dermal cells
Laser treatment for tattoo pigment
Laser type Wavelength ( nm) Tattoo pigment colour
Other conditions
• Lentigines,
• Nevus of Ota
• Café-au-lait macules
• Melanocytic nevi
• Side effects: pigment & textural changes, allergic reactions, ink darkening,
tissue aerosolization with possible infectious particles.
Interactions During Hair Removal
Mechanism
• These work by subtle thermal effects on the dermis, presumably
stimulating a wound healing response
• Stimulating turnover
Uses
• Scars,
• Fine rhytides,
• Telangiectasias,
• Dermatoheliosis
• Poikiloderma
• Ablative FP may also bean effective mechanism for topical drug delivery,
by providing many channels directly into the dermis.
Laser-Based Diagnostics
The retina
The directionality of a laser beam permits the ray to be
focused to an extremely small spot on the retina. A
collimated laser will be concentrated by a factor of
100,000 when passing from cornea to retina.
Visible or near IR lasers (400
nm to 1400nm) are particularly
dangerous to the retina and
always requires eye-protection
when working with these kind
of lasers.
Protection to the eye
Eye protection
Eyewear (goggles) is the most common laser protective
measure, especially for open laser beams. It should be
good design with all around shielding and adequate
visible light transmission.
• Drapes, clothing, dry hair and plastic • Remember to place the laser in
materials, including endotracheal STANDBY mode when not actually
tubes, can be ignited, especially treating the patient
when oxygen is in use • Avoid inadvertently activating the
laser foot-switch
• Greatest risk is with the CO2 and • Moisten any hair near the treatment
erbium:YAG lasers used for skin field; remove mascara and eye
resurfacing and ablative fractional makeup when working around
treatments eyelids
• Alcohol, acetone or other flammable
skin-cleaning solutions must be
allowed to completely dry before
laser use
• Reduce intraoperative oxygen
concentration to <40%
• A fire extinguisher and water should
be readily available
Cutaneous burns
• POSSIBLE CUTANEOUS • PREVENTION OF
BURNS CUTANEOUS BURNS
• Can occur with essentially • Knowledge and careful
all dermatological laser, IPL, observation of specific
RF or therapeutic clinical endpoint responses
ultrasound devices for a particular laser–lesion
• Primarily due to improper combination
device, dosimetry and/or
treatment technique
“Plume” materials
• INHALATION OF LASER- • PREVENTION OF LASER
GENERATED “PLUME” “PLUME” BIOHAZARDS
MATERIALS • Smoke evacuator and good
• Particularly with resurfacing or ventilation are most effective
vaporization of hair during its measures
removal; latter can release
irritating sulfur and other • Sub-micrometer surgical filter
oxides masks provide some
protection when worn
properly
1) FITZPATRICK’S DERMATOLOGY IN
GENERAL MEDICINE
2) ROOK’S TEXTBOOK OF DERMTOLOGY
3) IADVL TEXTBOOK & ATLAS OF
DERMATOLOGY BY R.G. & AMEET
VALIA
4) TEXT BOOK OF DERMATOLOGY BY
BOLOGNIA 3ed
THANK YOU