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Future technologies in dermatology
1. Future Technologies in
Dermatology
Dieter Manstein, M.D. Ph.D.
Wellman Center for Photomedicine
Massachusetts General Hospital
Harvard Medical School
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. General Objectives
Efficacy
Selectivity, safety
Side effects, down time
Pain
Overcoming skin barrier
getting things in or out
Skin‘rejuvenation’
Costs
4. Cooling is the New Hot
- Selectivity without Laser -
Typically cooling as adjunct with SP
(Epidermal protection for laser)
Selective Cryolipolysis:
5. Selective Cryolipolysis
Yucatan Pig
Untreated 16 Days Post Treatment
A C
B D
Manstein et al., ASLMS 2008
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. 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
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. 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. 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. OCT
- Schema - Light to reference arm
mirror
Broadband
Broadban
Light (1
d light
source 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. OCT
Examples of Skin Imaging
plate
nail bed matrix
1.2 mm
Eccrine ducts Hair
Photos: John Strasswimmer Group: Johannes F. de Boer
21. Fluorescence and Fluorescence
Anisotropy Imaging of Nonmelanoma
Micronodular BCC Skin Cancer
Fluorescence confocal image; Fluorescence Fluorescence
stain MB Emission Anisotropy
Collagen
Cancer
Histopathology; Stain: H&E
Group: Anna Yaroslavsky
Yaroslavsky et al., 2006
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 PHOTOTHERMOLYSIS
1 Month post TX, =1206 & 1065 nm
OF DERMAL TARGETS USING AN IR-FIBERLASER IN
P= 1.5 & 10 W ,t= 1.5 s COMBINATION WITH FOCUSING AND CONTACT COOLING
E= 17.25 J, focusing D. Manstein, M. Poureshagh, R. R. Anderson, I. Yaroslavsky, G.
B. Altshuler
23. The Future Trend
- Driven by Market Size -
Dermatologists and Plastic Surgeons (Special
(max. ~10.000 users)
ro d c y,
cti t
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Ad
173 million Consumers
15 - 60 years old
(US Census 2000)
Market Size
24. Specific Needs for Different
Markets
Specialist’s Device Home use Device
Efficacy Safety
Others Safety
Safety
Others
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