Waldorf H A, Alster T S, McMillan K, Kauvar A N, Geronemus R G, Nelson J S
Laser and Skin Surgery Center of New York, NY 10016, USA.
Dermatol Surg. 1997 Aug;23(8):657-62. doi: 10.1111/j.1524-4725.1997.tb00385.x.
The objective of this study was to determine the effectiveness of a dynamic cooling device (DCD), spraying the skin with a brief spurt of cryogen prior to the laser pulse, in reducing transient pain associated with 585-nm pulsed dye laser (PDL) treatment of port-wine stains (PWS), and reducing epidermal damage (hypo/hyperpigmentation) caused by this laser during PWS treatment.
Matched treatment sites were compared with and without the use of the cryogen spray in 47 patients at two investigational sites. Pain ratings, clearance of the PWS, and pigmentation changes were assessed. The results were analyzed by skin type and patient age.
A statistically significant reduction in pain ratings was found in all patient groups using the DCD without changing the efficacy of PWS clearance. Pain reduction was most remarkable in patients with darker skin types. Dynamic cooling prevented the occurrence of epidermal damage or pigmentation change in most cases.
This study suggests that dynamic cooling can dramatically diminish pain during PWS treatment with the 585-nm PDL without reducing treatment efficacy. The absence of epidermal damage in most patients suggests that precooling with the DCD may allow the use of higher laser fluences to expedite clearance without inducing epidermal change. Dynamic cooling has potential use with other lasers and different lesions where discomfort and epidermal effects limit therapy.
本研究的目的是确定一种动态冷却装置（DCD）的有效性，即在激光脉冲前向皮肤喷射短暂的低温制冷剂，以减轻与585纳米脉冲染料激光（PDL）治疗葡萄酒色斑（PWS）相关的短暂疼痛，并减少该激光在PWS治疗期间引起的表皮损伤（色素减退/色素沉着）。
在两个研究地点对47例患者的匹配治疗部位进行了使用和不使用低温制冷剂喷雾的比较。评估了疼痛评分、PWS的清除情况和色素沉着变化。结果按皮肤类型和患者年龄进行分析。
在所有患者组中，使用DCD均发现疼痛评分有统计学显著降低，且不改变PWS清除的疗效。皮肤颜色较深的患者疼痛减轻最为明显。动态冷却在大多数情况下可防止表皮损伤或色素沉着变化的发生。
本研究表明，动态冷却可在不降低治疗效果的情况下，显著减轻585纳米PDL治疗PWS期间的疼痛。大多数患者未出现表皮损伤表明，用DCD预冷可能允许使用更高的激光能量密度来加快清除速度，而不会引起表皮变化。动态冷却在其他激光和因不适及表皮效应限制治疗的不同病变中具有潜在应用价值。
