Weiss R A, Sadick N S
Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Dermatol Surg. 2000 Nov;26(11):1015-8. doi: 10.1046/j.1524-4725.2000.0260111015.x.
Intense pulsed light (IPL), utilizing noncoherent yellow, red, and near-infrared wavelengths can be used to treat telangiectasias. In order to circumvent epidermal heating and allow greater fluence to be delivered safely, a new device that circulates water around the IPL crystal in contact with the skin to provide continuous cooling at 1 degrees C-4 degrees C range was developed.
To observe the effects of contact cooling on IPL treatment of leg telangiectasias.
A total of 25 patients were treated using two similar sites of matted telangiectasias on the leg, one site was treated without epidermal cooling and the other with the epidermal cooling crystal collar device. Results were evaluated by comparison with pretreatment photographs at 1 month. At one treatment center, a crossover was performed at the 1-month visit in which the non-E3C site was treated by cooling. Parameters consisted of a 570 nm filter, coupled pulses of 2-2.5 msec/6-7 msec with a 10-msec delay with fluences of 38-40 J. On the site receiving contact cooling the fluence was increased by 10% (4 J/mm2). Sites were graded worse, unchanged, or improved (RAW) or on a numerical scale of 1-4 (NSS).
Compared to the contact cooling sites, uncooled sites showed 7 were improved, 5 were unchanged, and 3 were worsened, but cooled sites showed 10 were improved, 5 were unchanged, and none were worsened (P<.05). The grading scale on 10 patients revealed a mean improvement of 1.7 for noncooled sites and 2.7 for cooled sites (P<.001). For crossover treatment, eight noncooled sites (unchanged or worsened) were subsequently treated with cooling, demonstrating six improved (P<.001) and two with no change. Less erythema and edema was noted at all cooled sites. Furthermore, pain was significantly reduced with cooling (P<.003). Epidermal injury involving hyper- or hypopigmentation, crusting, or vesiculation was not observed in any of the cooled sites, but was recorded in three of the noncooled sites.
These data indicate that continuous epidermal cooling with IPL allows delivery of higher fluences with less pain and fewer side effects. Efficacy is significantly improved using the coupled short pulse/long pulse protocol. An additional benefit is that IPL treatment becomes less operator dependent because the chilled crystal may be placed directly in contact with the skin.
强脉冲光（IPL）利用非相干的黄色、红色和近红外波长可用于治疗毛细血管扩张。为了避免表皮受热并能安全地传递更高的能量密度，研发了一种新设备，该设备使水在与皮肤接触的IPL晶体周围循环，以在1摄氏度至4摄氏度范围内提供持续冷却。
观察接触式冷却对IPL治疗腿部毛细血管扩张的效果。
共25例患者参与研究，其腿部有两处类似的交织状毛细血管扩张部位，一处不进行表皮冷却处理，另一处使用表皮冷却晶体颈圈装置进行处理。1个月后通过与治疗前照片对比评估结果。在一个治疗中心，1个月复诊时进行交叉治疗，即对未进行表皮冷却处理的部位进行冷却治疗。参数包括570纳米滤光片，2 - 2.5毫秒/6 - 7毫秒的耦合脉冲，延迟10毫秒，能量密度为38 - 40焦耳。在接受接触式冷却的部位，能量密度增加了10%（4焦耳/平方毫米）。对治疗部位按变差、不变或改善（RAW）进行分级，或采用1 - 4的数字评分（NSS）。
与接触式冷却部位相比，未冷却部位显示7处改善、5处不变、3处变差，但冷却部位显示10处改善、5处不变且无一处变差（P<0.05）。对10例患者的评分显示，未冷却部位平均改善1.7分，冷却部位平均改善2.7分（P<0.001）。对于交叉治疗，8处未冷却部位（不变或变差）随后进行冷却处理，结果显示6处改善（P<0.001），2处无变化。所有冷却部位的红斑和水肿均较轻。此外，冷却显著减轻了疼痛（P<0.003）。在任何冷却部位均未观察到涉及色素沉着过度或不足、结痂或水疱形成的表皮损伤，但在3处未冷却部位有记录。
这些数据表明，IPL联合持续表皮冷却可传递更高能量密度，且疼痛减轻、副作用减少。采用耦合短脉冲/长脉冲方案可显著提高疗效。另一个好处是，IPL治疗对操作人员的依赖性降低，因为冷却晶体可直接与皮肤接触。
