Future technologies in dermatology

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Future technologies in dermatology

  1. 1. Future Technologies in DermatologyDieter Manstein, M.D. Ph.D. Wellman Center for Photomedicine Massachusetts General Hospital Harvard Medical School
  2. 2. Disclaimer Presentation is intended to stimulate use of new technologies & concepts. The selection of is based on author’s assessment and not complete.
  3. 3. General Objectives Efficacy  Selectivity, safety  Side effects, down time  Pain  Overcoming skin barrier  getting things in or out Skin‘rejuvenation’ Costs 
  4. 4. Cooling is the New Hot - Selectivity without Laser - Typically cooling as adjunct with SP  (Epidermal protection for laser) Selective Cryolipolysis:
  5. 5. Selective Cryolipolysis Yucatan Pig Untreated 16 Days Post TreatmentA CB D Manstein et al., ASLMS 2008
  6. 6. Cryolipolysis Coolsculpting - ZeltiqControl Unit
  7. 7. Cooling is the New Hot - Selectivity without Laser - Typically cooling as adjunct with SP  (Epidermal protection for laser) Selective Cryolipolysis:  Selective effects on fat, biological selectivity rather than selective temperature field Other indications (Acne, Xanthelasma, Cryoneuromoduloation, etc.)  Modify geometry, T/t, T
  8. 8. Pain Management w/o Drugs Cooling  Surface cooling with laser (epidermal protection)  Cryoanalgesia Very small laser spots  No pain due to lack of spatial or temporal summation Gate control  Competitive pain blockage (distraction) Repetitive exposures / treatments
  9. 9. Repetitive Pulses = Enhanced Efficacy  Pulse stacking (quick, high energy, bulk heating, To )  Repetitive pulses (quick, low energy) EN=Es x N-1/4  N=16  2x  N=81  3x  N=256  4x  N=615  5x  Repetitive pulses (slow, minutes)  Altered tissue optics (erythema, edema)  Altered chromophores (rupture, stasis, color change)  Altered biological response (HSP, sub-lethal damage)  Multiple treatments (slow, days)  Tissue repair limitations *Roider J, Hillenkamp F, Flotte T, Birngruber R. Microphotocoagulation: selective effects of repetitive short laser pulses. Proc Natl Acad Sci U S A. 1993 Sep 15;90(18):8643-7.
  10. 10. Variation of Treatment Interval & Energy / Tx Total EnergyEnergy / TX 40 UEnergy / TX Total Energy 40 U Time
  11. 11. Combination: 1+1=3 Cooling and massage Heating and massage Preheating and SP  RF & SP  US & SP  IR & SP 11
  12. 12. Skin as a Barrier Limited drug delivery (SC) Limited light penetration  Absorption of melanin & blood  Scattering of shorter wavelengths  Small beams rapidly diverge Limited trans(epi)dermal elimination  Tattoo ink, lipids
  13. 13. Skin without Barriers -Getting Things in and out- Small diameter holes as a gateway
  14. 14. Small Diameter Holes as a Gateway Increasing Laser Pulse Energy 14
  15. 15. Small Diameter HolesA new Gateway into the Skin (?)
  16. 16. Skin without Barriers -Getting Things in and out- Small diameter holes as a gateway  Drug delivery  Optical energy delivery Needle Arrays  Fractional RF  Optical fiber arrays  Drug delivery Getting things out
  17. 17. True Rejuvenation Currently ‘rejuvenation’ used vaguely and no accepted standards by FDA True rejuvenation by (fractional) laser procedures (?)  Regeneration by controlled destruction  Reduction of senescent skin cells  Allowing for controlled cell proliferation from SCs Rejuvenation  hallmarks of aging 
  18. 18. Smart Devices Smart is safer  Real-time pigmentation feedback  Aim and shoot  Tracking (avoid bulk heating) Smart saves energy  Most of SP energy is not utilized  More energy efficient = more cost effective 18
  19. 19. OCT - Schema - Light to reference arm mirrorBroadbandBroadbanLight (1d lightsource 2 x 2 splitter 0 1.2 mm Light focused on skin Detection of interference fringes = one A-line Group: Johannes F. de Boer
  20. 20. OCTExamples of Skin Imaging platenail bed matrix 1.2 mm Eccrine ducts HairPhotos: John Strasswimmer Group: Johannes F. de Boer
  21. 21. Fluorescence and Fluorescence Anisotropy Imaging of NonmelanomaMicronodular BCC Skin CancerFluorescence confocal image; Fluorescence Fluorescencestain MB Emission Anisotropy Collagen Cancer Histopathology; Stain: H&E Group: Anna YaroslavskyYaroslavsky et al., 2006
  22. 22. Robotic Devices - Putting Diagnostic and Treatment Together - H&E OCT device and imaging:1 stain mm Johannes F. de Boer & Mark Pierce ASLMS 2001: SPATIALLY CONFINED PHOTOTHERMOLYSIS1 Month post TX, =1206 & 1065 nm OF DERMAL TARGETS USING AN IR-FIBERLASER INP= 1.5 & 10 W ,t= 1.5 s COMBINATION WITH FOCUSING AND CONTACT COOLINGE= 17.25 J, focusing D. Manstein, M. Poureshagh, R. R. Anderson, I. Yaroslavsky, G. B. Altshuler
  23. 23. The Future Trend - Driven by Market Size - Dermatologists and Plastic Surgeons (Special (max. ~10.000 users) ro d c y, cti t General practitioners and other physic s p an og nd du os ) on tre as ty nol en (m safe ech riv -d Spas and Salons t t ke cti ced in ar du n esM re ha nc en va on Ad 173 million Consumers 15 - 60 years old (US Census 2000) Market Size
  24. 24. Specific Needs for Different MarketsSpecialist’s Device Home use Device Efficacy  Safety Others  Safety  Safety  Others
  25. 25. Summary Cooling from a new perspective Pain management Skin without borders Repetitive pulses/ treatments Combination: 1+1=3 True skin rejuvenation Smart devices (Imaging & Tx) Home use devices
  26. 26. ThanksWellman Center for Photomedicine, Boston Harvard Medical School

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