Patent Grant
11738206
This invention relates generally to electromagnetic radiation-based medical treatment systems, and more specifically to systems and methods for controlling the temperature of a target skin area in the treatment of dermatological conditions. The invention includes controlling the duration of laser pulses in performing such treatment.
A variety of dermatological conditions are treatable using electromagnetic radiation (EMR). Sources of EMR in dermatological treatment systems may include, without limitation, lasers, flashlamps, and RF sources. Laser are frequently used as an EMR source to treat a range of conditions including acne vulgaris, abnormal pigmentation, vascular skin conditions (e.g., spider veins), wrinkles and fine lines, and dyschromia, and many others. Both pulsed and continuous-wave (CW) laser systems have been used, although pulsed lasers are more commonly employed.
Many dermatological EMR systems use a laser to photo-thermally damage a target tissue while preserving surrounding or adjacent non-targeted tissues or structures. The principle of selective photothermolysis, which involves thermally damaging a target tissue to promote a healing response, has led to the development of a variety of laser applications as standard of care in many medical fields such as ophthalmology and dermatology.
Damage to a target tissue during photothermolysis involves raising the temperature of the target tissue to a damage threshold temperature for a specified time period. For a given level of thermal damage desired, there is a tradeoff between the temperature to which the target tissue must be raised and the time that the target temperature must be maintained. The same thermal damage may be achieved using a lower temperature if the time of heating is increased; if a higher temperature is used, a shorter heating time can be used to achieve an equivalent level of thermal damage. To avoid thermal damage to non-targeted tissue, it is desirable to limit the heating time to the thermal relaxation time (TRT) of the target tissue. TRT is the time required for the target to dissipate about 63% of the thermal energy received from the pulse. It is related to the size of the target chromophore, and may range from a few nanoseconds for small chromophores such as tattoo ink particles, to hundreds of milliseconds for large chromophores such as leg venules. Accordingly, in many cases, a damage threshold temperature to achieve a desired level of thermal damage to the target tissue may be selected based on the TRT of the target tissue. For example, depending upon factors such as the laser power, fluence, spot size, etc. used in a given system, a damage threshold temperature to achieve a desired level of photothermolysis at time periods approximately equal to (e.g., slightly longer or shorter than) the TRT may be selected.
Photothermolysis can be achieved when three conditions are met: 1) the wavelength of the laser is chosen to have a preferential absorption in the target tissue over the surrounding tissue; 2) the pulse duration of the laser should be equal to or less than (=<) the thermal relaxation time (TRT) of the target tissue; and 3) the laser fluence (i.e., energy per unit area) must be sufficient to exceed the thermal damage threshold of the target tissue. Together, these principles permit laser systems to be developed that deliver energy at specific wavelengths, pulse durations, and fluences to provide controlled energy to damage target tissue while leaving non-targeted surrounding tissues and structures substantially unaffected.
Selectivity as well as overall safety would be improved if the temperature of the skin could be dynamically controlled. In particular, most laser-based dermatological treatment systems do not provide reliable control of the temperature of the skin during treatment, since pulse durations and the number of pulses applied to a target treatment area are typically selected by a user and maintained for a given treatment session until manually changed by the system user (e.g., a laser technician, physician, nurse, etc.). There is a need for laser-based treatment systems providing better control of the skin temperature. Some embodiments of the present invention achieve this by using the actual skin temperature to provide feedback to the instrument to dynamically control the temperature during a treatment.
Ideally, thermal damage is highly localized to only the particular target tissue (e.g., a particular skin layer at a particular location, or particular structures such as chromophores within a skin layer at a particular location), with nearby non-targeted tissues/structures remaining unaffected and thus available to facilitate the healing response in the targeted tissue. However, the structural complexity of the skin, which includes a variety of layers each having unique structural and functional characteristics, has limited the development of effective EMR-based treatments for many skin conditions.
Effectively reaching and limiting thermal damage to target structures within skin tissue by laser radiation is complicated by a variety of intrinsic and extrinsic factors. Intrinsic factors include, without limitation, the depth of the target structure within tissue and the associated absorption of light by non-targeted structures overlying the target (which may involve a plurality of intervening structures each having different light absorption and thermal characteristics), the scattering of light within the skin above the target, the TRT of the target structure and intervening non-target structures, and the removal (or non-removal) of heat by blood flowing through dermal and subdermal layers. Extrinsic factors include, also without limitation, the wavelength, pulse width, power, fluence, spot size, and other characteristics of the laser used to treat the target tissue or structure.
Acne vulgaris, more commonly referred to simply as acne, is the most common reason for office visits to dermatologists in the United States. Over 60 million Americans suffer from acne. Treatment options include topical applications such as disinfectants (e.g., benzoyl peroxide), retinoids (e.g., Retin-A), and antibiotics (e.g., clindamycin and erythromycin), as well as ingested compounds such as antibiotics (e.g., tetracycline), hormonal treatments (e.g., birth control pills), isotretinoin (Accutane, which has significant side effects), and optical treatments such as laser treatments, which have the benefit of avoiding the side effects and inconvenience of pharmaceuticals and topical treatments but which, at present, have limited effectiveness for a variety of reasons including the previously noted problems of skin tissue complexity and the limitations of existing laser systems. More recently, nanosphere particles have been deposited into skin pores and/or follicles, followed by heating of the nanoparticles with laser light to treat acne. Photodynamic therapies, in which an agent is applied to the skin to increase its sensitivity to light, have also been used in conjunction with laser or other light (e.g., blue light) to treat acne.
There is a need for improved laser systems having greater efficacy for treating acne. The present invention discloses systems and methods using lasers to achieve improved treatments for a variety of medical conditions including, without limitation, acne. In one aspect, the present disclosure provides improved pulse duration control to avoid damage to non-targeted structures and to more precisely control thermal damage to targeted structures. In one aspect, the disclosure provides systems and methods to ensure that each pulse, or a group of pulses, achieves a desired skin temperature, and does not exceed the desired temperature. This becomes highly important when the patient's skin varies in thickness or composition, such that target skin areas (e.g., spots to which one or more laser pulses are applied) may reach significantly different temperatures when the same laser pulse is applied to different skin areas. The disparity in skin temperatures for a pre-defined laser pulse for different skin areas is magnified when the target structure is deeper in the skin, because of the greater scattering and absorption of energy by overlying tissue that occurs at greater skin depths.
Heating in tissues depends upon both the absorption of the irradiated tissue structures for the wavelength of laser light used, as well as their thermal relaxation times, which is a measure of how rapidly the affected structure returns to its original temperature. By delivering the laser energy in a pulse with a time duration less than the TRT of the target tissue, highly localized heating (and destruction) of a tissue target structure (e.g., melanin, sebum, sebaceous gland, collagen) can be achieved, thereby minimizing damage to non-target structures (e.g., non-targeted skin layers, blood vessels, etc.). If the laser pulse duration is less than the TRT of the target tissue, no significant heat can escape into non-target structures, and damage to non-target structures is limited.
For deeper target structures such as sebaceous glands, which often range from 0.3-2.0 mm (more commonly 0.5-1.0 mm) below the outer surface of the epidermis, damage to overlying tissue structures is difficult to control or limit, since the laser energy must pass through those tissue structures before reaching the target tissue structures. The overlying tissue structures absorb energy depending upon their respective depths and absorption coefficients, with the result that undesired damage may frequently be done to tissue structures overlying deeper target structures. In some instances, the target structures are either sufficiently shallow, or the treatment temperature to which the target structures are raised is sufficiently low, that the heating of overlying structures may not cause excessive damage. Even where the risk of overheating the overlying structures of a relatively deep target is minimal, however, accurate temperature control of the target structure may be poor, resulting in overheating or underheating or the target structure, discomfort to the patient, or a combination of such undesired effects.
The skin surface may be cooled to limit the temperature increase (and consequent damage) to non-target overlying structures, as well as to limit discomfort and pain to the patient. However, existing systems lack precise control of the cooling process, such that achieving both a desired level of photothermal damage to deeper target structures and minimizing damage to non-target overlying structures has proven elusive. In many cases, the skin is cooled either too much—in which case the deeper target structure fails to reach a temperature damage threshold—or too little, in which case non-target overlying structures are damaged and the deeper target structure may be excessively damaged. There is a need for laser-based treatment systems having improved temperature control of the cooling process to ensure that target structures reach a desired temperature (e.g., a thermal damage temperature) and that thermal damage to non-target structures is minimized or controlled to an acceptable level.
In U.S. Pat. No. 8,474,463, a treatment system for acne vulgaris is described that uses a pulsed laser to damage sebaceous gland tissue. The system uses a laser having a wavelength in the range of 800 nm and 1200 nm, with pulses having a peak power of 10-14 kW for pulses in the range of 100-3000 μsec, a pulse repetition rate of 2-12 Hz, and a fluence of at least 8 J/cm2, typically 10-20 J/cm2. The system of the '463 patent, however, lacks the precise control of temperature necessary to achieve with consistency both a desired damage level to the target structure and avoid or limit damage to overlying structures. There is a need for dermatological laser systems that are able to efficiently treat a variety of medical conditions to achieve these goals.
In one embodiment, the invention comprises a method of treating the skin of a patient with a therapeutic laser pulse, the method comprising: a) applying a contact cooling element comprising a cooling window to a first skin area of the patient; b) cooling at least a target skin area within the first skin area from a first surface temperature to a second surface temperature prior to initiating the application of a therapeutic laser pulse to the target skin area; c) initiating the application of a therapeutic laser pulse to the target skin area through the cooling window at a first timepoint; d) determining a surface temperature of the target skin area at least once during the application of the therapeutic laser pulse based on infrared energy radiated from the target skin area through the cooling window; and e) terminating the application of the therapeutic laser pulse to the target skin area at a second timepoint based at least in part on the at least one surface temperature determination.
In one embodiment, the invention provides a method of treating the skin of a patient with a therapeutic laser pulse, the method comprising: a) applying a contact cooling element comprising a cooling window to a first skin area of the patient; b) initiating the application of a therapeutic laser pulse to the target skin area through the cooling window at a first timepoint; c) determining a surface temperature of the target skin area one or more times during the application of the therapeutic laser pulse based on infrared energy radiated from the target skin area through the cooling window; d) terminating the application of the therapeutic laser pulse to the target skin area at a second timepoint based at least in part on the at least one surface temperature determination; and e) performing at least one cooling action selected from 1) cooling the target skin area from a first skin temperature to a second skin temperature using the contact cooling element prior to initiating the application of the therapeutic laser pulse to the target skin area; and 2) cooling the target skin area from a third skin temperature to a fourth skin temperature using the contact cooling element after terminating the application of the laser pulse to the target skin area.
In one embodiment, the method comprises a method of treating the skin of a patient with a therapeutic laser pulse, the method comprising: a) applying a contact cooling element comprising a cooling window to a first skin area of the patient; b) cooling at least a target skin area within the first skin area from a first surface temperature, using the contact cooling element; c) determining a surface temperature of the target skin area a plurality of times during the application of the contact cooling element to the first skin area based on infrared energy radiated from the target skin area through the cooling window prior to initiating the application of a therapeutic laser pulse to the target skin area; d) initiating the application of a therapeutic laser pulse to the target skin area through the cooling window at a first timepoint based on one or more of the plurality of surface temperature determinations of the target skin area; e) determining a surface temperature of the target skin area at least once during the application of the therapeutic laser pulse, based on infrared energy radiated from the target skin area through the cooling window; and f) terminating the application of the therapeutic laser pulse to the target skin area at a second timepoint based at least in part on the at least one surface temperature determination.
Exemplary embodiments of the present disclosure are illustrated in the drawings, which are illustrative rather than restrictive. No limitation on the scope of the technology, or on the claims that follow, is to be implied or inferred from the examples shown in the drawings and discussed herein.
Treatment of many dermatological conditions involve using laser light to heat a target skin area to thermally damage a selected structure within the target skin area. Laser treatment may be ablative or non-ablative, and may result in a healing response to the damaged area to improve the patient's condition. Consistently accurate delivery of energy to targeted structures to achieve a desired level of damage to a target structure, while minimizing the delivery of energy and corresponding damage to non-targeted structures, has remained an unrealized goal. The present disclosure is directed to providing systems and methods to achieve these objectives.
As used herein “target skin area” refers to the skin receiving the energy of a laser pulse. The target skin area may include the surface skin area illuminated by the laser pulse, as well as deeper structures beneath the surface skin area that receive at least a portion of the energy from the laser pulse. As such, “target skin areas” treated by a laser pulse may refer to a volume of skin as opposed to a true area of an outer surface of the epidermis.
As used herein, “surface temperature” in reference to a target skin area refers to the temperature of the target skin area as determined or measured at or above the surface of the skin. In particular, where infrared energy radiated from a target skin area is used to measure the temperature of the skin surface, the surface temperature determination includes energy radiated from deeper in the epidermis in addition to the outermost layer of cells. Without being bound by theory, the strong scattering effects of infrared wavelengths within the epidermis limit the energy emitted and detected to the upper 100 microns, and primarily the upper portions thereof. Consequently, “determining a surface temperature” based on detection of radiated infrared energy refers to the determination of a composite or average temperature of the upper portions (e.g., tens of microns in depth) of the epidermis, and not merely the outermost layer of skin cells. In embodiments of the present invention, it provides a reliable and precise determination of the temperature of the uppermost portion of the epidermis.
In one aspect, the present invention comprises systems and methods for improved temperature control of a target skin area during the delivery of one or more laser pulses in the treatment of a medical condition. In some embodiments, the present invention comprises systems and methods for control of a surface temperature of a target skin area of a patient during a laser pulse in the treatment of a dermatological condition. In some embodiments, the present invention provides improved temperature control of a target non-surface (i.e., deeper) structure in a target skin area of a patient during a laser pulse. By providing accurate temperature control of a target skin area during the delivery of laser pulses, the invention provides systems and methods with improved efficacy, safety and/or comfort to patients being treated for a range of dermatological conditions.
In one aspect, the invention provides systems and methods of controlling a temperature of a target skin area during a laser pulse to avoid overheating the target area. Such systems allow laser treatments that avoid excessive damage to a target structure within the target skin area, and/or undesired damage to overlying non-targeted structures. In one aspect, the invention provides systems and methods of controlling a temperature of a target skin area during a laser pulse to avoid underheating a target structure, resulting in too little damage to the target structure.
In one aspect, the present invention discloses systems and methods for minimizing the temperature increase of non-target structures overlying a target structure within a target skin area during the delivery of a laser treatment to raise the target structure from a first temperature to a second temperature, such as a damage threshold temperature for the target structure. In one embodiment, the laser treatment comprises a single pulse, and the temperature of the target skin area is measured one or more times during the delivery of the pulse.
In one embodiment, the laser treatment comprises a plurality of pulses made during a single heating episode of the target skin area, and the temperature of the target skin area is determined one or more times during the single heating episode. As used herein, a “single heating episode” involves a plurality of pulses where the first pulse raises the temperature of the target skin area from a first or baseline temperature immediately prior to the first pulse, and each successive pulse in the heating episode is applied before the target skin area returns to the first or baseline temperature. Where a plurality of pulses are used to heat the target skin area to a desired temperature in a single heating episode (e.g., a damage threshold temperature for a target structure), the temperature of the target skin area may be determined during a pulse, between pulses, or a combination of during and between pulses of the single heating episode.
In one aspect, the invention comprises a method of determining the length of a laser treatment pulse based on determining the surface temperature of a target skin area one or more times during the delivery of the laser treatment pulse. By determining the surface temperature of the target treatment area during the delivery of the laser treatment pulse, the laser pulse may be terminated when the skin reaches a desired temperature that avoids overheating the target skin area and causing excessive damage to non-targeted structures, as well as terminating the pulse too early, with too little damage to the target structure(s). In some embodiments, the invention may also include skin cooling (e.g., contact cooling applied to the skin surface) to enable heating of deeper structures (such as a sebaceous gland or the root of a hair follicle in the dermis) to a damage threshold temperature while minimizing the heat delivered to overlying non-targeted tissue structures.
In one aspect, the invention comprises a method of determining the duration of a laser treatment comprising a plurality of laser pulses in a single heating episode of a target skin area from a first surface temperature to a second surface temperature. The duration of the laser treatment is based on determining the surface temperature of the target skin area a plurality of times during the delivery of the plurality of laser treatment pulses.
As used in connection with temperature determinations, “real-time” refers to temperature determinations (e.g., temperature measurements or calculations based on data from a temperature sensor) performed during an action (e.g., during the cooling of a target skin area or during the delivery of a laser pulse to a target skin area) and used by a processor to determine a timepoint for terminating the action or initiating the performance of another action. In one aspect, the invention comprises real-time temperature determinations during the cooling of a first skin area, and the temperature determinations may be used to perform an action such as terminating the cooling process, initiating the delivery of a laser pulse to a target skin area within the first skin area being cooled, or terminating the delivery of a laser pulse to a target skin area within the first skin area being cooled. In another aspect, the invention comprises real-time temperature determinations during the delivery of a laser pulse to a target skin area without cooling, and using the temperature determinations as a basis for terminating the delivery of the laser pulse to a target skin area.
In one aspect, the invention comprises real-time temperature determinations performed during the delivery of a therapeutic laser pulse (or during or between pulses delivered as a plurality of pulses comprising a single heating episode), which may be used (e.g., by a processor executing a treatment algorithm) to perform an action such as terminating the delivery of a laser pulse, initiating the delivery of one of a plurality of pulses comprising a single heating episode, adjusting a parameter of a therapeutic laser pulse, or initiating, terminating, or adjusting (e.g., increasing the rate of) a cooling process associated with the delivery of therapeutic laser pulse(s).
In one aspect, the invention comprises a method of treating a patient having hyperhidrosis (i.e., excessive sweating) by controlled heating of a target skin area from a first surface temperature to a second surface temperature, where the second surface temperature corresponds to a temperature resulting in thermal damage to a sweat gland within the target skin area. In one embodiment, the duration of the laser treatment pulse is based on determining the surface temperature of the target skin area a plurality of times during the delivery of the laser treatment pulse. In one embodiment, the laser treatment pulse is terminated when the second surface temperature reaches a value indicative of the deeper sweat gland reaching a sweat gland treatment temperature. The second surface temperature corresponding to the sweat gland reaching the sweat gland treatment temperature may be identified prior to treatment, e.g., by thermal (mathematical) modeling of the heating of the target skin area based on the parameters of the treatment laser such as wavelength, energy flux, and thermal characteristics of the target skin area such as thermal conductivity, the absorption coefficients of various tissue structures and/or chromophores, etc.
In one aspect, the invention comprises a method of treating a patient having acne vulgaris by controlled heating of a target skin area from a first surface temperature to a second surface temperature, where the second surface temperature corresponds to a temperature resulting in thermal damage to a sebaceous gland within the target skin area. In one embodiment, the duration of the laser treatment pulse is based on determining the surface temperature of the target skin area a plurality of times during the delivery of the laser treatment pulse. In one embodiment, the laser treatment pulse is terminated when the second surface temperature reaches a value indicative of the deeper sebaceous gland reaching a sebaceous gland treatment temperature. The second surface temperature corresponding to the sebaceous gland reaching the sebaceous gland treatment temperature may be identified by thermal modeling as previously discussed.
The dermis 104 has a thickness of about 1-5 mm (1000-5000 μm). It contains the blood vessels, nerves, hair follicles, collagen and sweat glands within the skin. Because skin conditions frequently involve structures in the dermis, many laser systems must include sufficient energy to penetrate into the dermis to reach and treat structures therein. Careful selection of a number of parameters must be made in the design and construction of laser systems for treatment of a variety of skin conditions to achieve a desired level of damage to a target structure while minimizing or avoiding damage to non-targeted (e.g., overlying) structures. For example, incorrect selection of the laser wavelength, pulse width, energy per pulse, the use (or nonuse) of a seed laser, or the pump energy of the laser source or amplifier may result in undesired damage as well as poor performance in treating a dermal structure of interest. Numerous other system choices, such as the use or non-use of an articulating arm for delivery of the laser light to a handpiece for application to the patient's skin, may also affect overall system performance.
The lowest layer of the skin is the hypodermis 106, which includes adipose tissue and collagen. The hypodermis 106 helps control body temperature by insulating the structures of the body below the skin. In addition, the hypodermis protects the inner body tissues from damage by absorbing shock and impacts from outside the body. Because the hypodermis contains fat, its thickness varies widely from person to person based on diet, genetic makeup, and other factors.
Epidermis 210 includes melanin (not shown), a dark pigment found in tissues of the hair, skin and eyes. Melanin, the primary determinant of skin color, is located within globular structures known as melanosomes, which are produced by skin cells called melanocytes. Darker skin has more melanosomes (and thus more melanin) per unit skin area compared to lighter skin. Laser systems targeting deeper structures such as sebaceous gland 219 in the dermis may present a higher risk of patient discomfort where wavelengths having a relatively high absorption coefficient in melanin are used. Without being bound by theory, when laser light at wavelengths readily absorbed by melanin is applied to dark skin (or dark tattoos having ink particles that absorb laser light at similar wavelengths to melanin), the energy absorbed by the melanin (or tattoo ink particles) attenuates part of the laser energy that otherwise would reach deeper structures absent the melanin or ink particles, heating the skin of the epidermis and/or upper dermis to a greater degree than lighter/un-tattooed skin. Additional energy—either by providing higher fluences, higher energy per pulse, or longer treatment times—must be applied to reach deeper structures to heat them to a target treatment temperature. However, higher pulse fluences and pulse energy may compound the problem, since the additional energy delivered in a shorter time period will cause the skin temperature to rise even faster than using lower fluences or energies. In addition, longer treatment times can only deliver more energy to the target if the energy is delivered within the TRT of the target tissue—otherwise, the additional energy largely leaks from the target tissue into adjacent non-target tissue.
Accordingly, in one aspect, the present invention provides laser treatment systems to minimize discomfort by adjusting one or more parameters based on the skin type of the patient. In one embodiment, the invention provides systems and methods for determining a skin type of a patient and automatically adjusting one or more treatment parameters based on the skin type of the patient. This may involve, for patients having darker skin types, one or more of: providing additional cooling of the patient's skin prior to applying a laser therapy to the patient's skin; lowering a first skin temperature at which a therapy pulse is initiated and applied to the patient's skin; lowering a fluence of a laser therapy; lowering a peak power of the laser pulses of a laser therapy; providing a longer pulse width of a pulsed laser therapy; and providing a larger beam diameter for a pulsed laser therapy.
Successful treatment of acne involves damaging sebocytes and/or sebaceous glands. This involves heating sebum, which produced by and located within the sebaceous glands, to damage the gland. Accordingly, it is desirable to select a wavelength of light that is highly absorbed by sebum, preferably more so than competing skin chromophores (e.g., water), to limit the damage to non-targeted tissue and concentrate the laser energy delivered into the targeted sebaceous gland to the exclusion of non-targeted tissues and structures. In addition, because sebaceous glands are relatively deep structures located in the dermis at depths of 300-2000 μm (0.3-2.0 mm), it is desirable to select a wavelength of light capable of non-ablative penetration to these depths.
As shown more clearly in
Referring again to
Referring to
The pulse in
Although persons of skill in the art will appreciate that many known methods and modes of precooling the skin may be used, the embodiment of
In alternative embodiments, non-contact cooling systems (e.g., cold air or other fluid circulated onto or across the surface of a target skin area) may be used to cool the skin. Without being bound by theory, it is believed that the thermal resistivity of the skin and the thermal coupling between the skin and gases such as air typically preclude non-contact systems from providing adequate cooling capacity during the delivery of laser pulses to both effectively treat deeper target structures and prevent the skin surface from reaching temperatures likely to result in significant discomfort. Accordingly, contact cooling systems are preferred cooling systems. In still other embodiments, evaporative cooling systems (e.g., sprayed coolant evaporating from the skin) may be used.
Referring to
Because direct measurement of the gland temperature is difficult or impossible given its depth within the skin, in embodiments of the present invention, surface skin temperature may be monitored as an indirect indication of the gland temperature. It should also be noted that, because the goal of the laser treatment process is to heat the sebaceous gland to a damage threshold temperature, the cooling of the gland (as opposed to the skin surface) shown by curve 510 in
Comparing
Certain systems and methods of the present invention are facilitated by a method of controlling the duration of a pulse to limit the surface temperature of a target skin area to a desired threshold.
In the embodiment of
In one embodiment, the laser pulse may be terminated after the first temperature determination that is at or above the temperature threshold. In another embodiment, the laser pulse may be terminated based on a predicted timepoint at which the skin surface will reach the threshold temperature, without requiring that the temperature be reached or exceeded. For example, periodic predictions of when the threshold temperature will be reached may be made, e.g., by fitting a straight line or polynomial function to the temperature data each time a subsequent temperature determination is made during pulse delivery, and projecting the function forward to determine a predicted timepoint when the temperature threshold will be reached. In such embodiments, after a predetermined number of measurements have been made (or after a plurality of predictions each result in a predicted timepoint for reaching the desired temperature that are within a predetermined interval of one another), the pulse may be terminated at the predicted timepoint, and no actual temperature determination at or above the threshold may be necessary.
Handpiece 620 includes a cooling system 622 for cooling a first skin area that includes a target skin area within the first skin area. Cooling system 622 includes a contact cooling element comprising a cooling window 628 maintained in a fixed position in contact with a heatsink portion of a thermoelectric cooler (TEC) 630 by a window frame 626. Cooling window 628 may comprise any of a variety of IR-transmissive materials, including sapphire, ZnS, diamond, ZnSe, and other thermally conductive material that are transmissive to infrared light. In alternative embodiments (not shown), the contact cooling element may comprise components or structures in addition to cooling window 628, such as a copper (or other material having a high thermal conductivity) cooling element that is not light-transmissive to provide additional cooling capacity.
TEC 630 may be a Peltier-type cooler and has a warm side and a cold side (not shown). The heatsink portion of the TEC 630 is part of the cold side and is used to remove heat from the cooling window 628 to maintain the cooling window at desired temperature as it contacts the first skin area. A cooling medium 632 removes heat from the hot side of the TEC 630 to prevent heat buildup in handpiece 620. In one embodiment, the cooling medium comprises circulating cold water, although other thermally conductive fluids or other materials may be used in different embodiments.
To ensure efficient skin cooling, it is necessary to maintain good contact between the skin and the cooling window 628 during treatment. In one embodiment (not shown), the invention comprises one or more contact sensing elements to detect when the cooling window 628 is properly in contact with the first skin area. The contact sensing element(s) may be coupled to, or separate from, cooling window 628 and/or frame 626, and may comprise, e.g., one or more electrical contacts capable of sensing electrical activity, conductivity, or resistance of the skin indicative of adequate skin/cooling window contact. Other contact sensing elements (e.g., ultrasonic sensors) detecting different skin parameters or features associated with proper contact (e.g., force, vibration, pressure, temperature, the presence of sweat or skin oils) may also be used.
One or more skin contact indicators (not shown) may alert a user to the contact status between the skin and cooling window 628. The skin contact indicator may indicate when the contact element(s) are—or are not—in good contact with the first skin area and may prompt the user to manipulate the handpiece to restore good contact when necessary. The skin contact indicator(s) may comprise, e.g., an LED indicator on handpiece 620 that displays a first color when good skin contact exists and a second color when the window 628 is not in proper contact with the skin. Other indicators, such as an audible sound or alarm, may also be provided, and the system may be interlocked such that the system will not apply (or will terminate) a laser pulse if good contact between the cooling window 268 and the skin is absent.
Handpiece 620 further includes a temperature sensor 624 for sensing a surface temperature of the target skin area. Temperature sensor 624 may, in various embodiments, sense the temperature of the target skin area one or more times before pulse delivery (e.g., during a precooling step), during pulse delivery, or after pulse delivery (e.g., during a postcooling step to minimize thermal damage and patient discomfort). During delivery of a therapeutic laser pulse to a target skin area, the surface temperature may be influenced by two different heating mechanisms, including energy absorbed directly from the laser, and thermal bloom resulting from energy conducted from deeper skin tissue as the thermal energy absorbed by deeper structures relaxes into the environment. Thermal bloom from deeper structures back to the skin surface may be a significant cause of epidermal damage in laser systems targeting relatively deep structures such as sebaceous or sweat glands. Therapeutic laser systems such as system 600 enable improved treatment outcomes by ensuring that the surface temperature of a target skin area remains below a desired surface temperature even while heating deeper structures to higher temperatures, minimizing both skin damage and patient discomfort.
Temperature sensor 624 may sense the surface temperature of the target skin area one or more times during the delivery of the laser pulse from diode laser 610. In various embodiments, temperature sensor 624 may be capable of sensing the surface temperature of the target skin area at from 10 to 1 million times per second. In one embodiment, the temperature sensor 624 comprises an infrared radiation detector to detect infrared energy radiating from the surface of the target skin area through the cooling window 628, and a processor (e.g., controller 640 as discussed below) to determine the surface temperature of the target skin area one or more times during a treatment pulse based on data received from the temperature sensor 624. It will be appreciated that other temperature sensors 624 may be used.
Handpiece 620 also includes a scanner 634 to sequentially direct laser pulses to different target skin areas within a first skin area in contact with cooling window 628. In some embodiments, cooling window 628 may provide contact cooling to a first skin area that is significantly larger than a single target skin area. In such embodiments, after a first target skin area is treated by a laser pulse, scanner 634 may be used to redirect subsequent pulses from the diode laser 610 to a new (i.e., second, third, etc.) target skin area for treatment within the first skin area cooled by the cooling window 628. When a desired number of target skin areas have been treated at a single cooling window position, the user may reposition the cooling window to a new position covering a new skin area, and a different group of target skin areas within the new skin area may be treated by the diode laser 610 using scanner 634. In one embodiment, scanner 634 may comprise a mirror (see
The system 600 further includes a controller 640, which may comprise one or more processing elements such as microprocessors, microcontrollers, field programmable gate arrays (FPGAs), etc. to control the operations of the laser treatment system. Controller 640 includes a pulse timing control unit 642 that controls the timing of the laser pulses from diode laser 610, including initiating the pulse at a first timepoint and terminating the pulse at a second timepoint. The pulse timing control unit 642 may receive data from temperature sensor 624, and may initiate the therapeutic laser pulse at a first timepoint based on, e.g., a determination that the surface temperature of the target skin area has been cooled to a desired temperature (e.g., a specific below body temperature such as 15° C., 10° C., 5° C., 0° C., −5° C., −10° C., etc.). Pulse timing control unit 642 may also terminate the therapeutic laser pulse at a second timepoint based on, e.g., a determination that the surface temperature of the target skin area has reached a threshold temperature (e.g., a surface temperature indicating that a deeper target structure such as a sebaceous gland has reached a damage threshold such as a temperature in the range of 60° C.-75° C.).
Controller 640 also includes a temperature sensing control unit 644 that controls the operation of the temperature sensor 624. In particular, temperature sensing control unit 644 ensures that the surface temperature of a target skin area is determined or measured at a desired (e.g., programmed or predetermined) sampling rate such as 10 or more times per second. Controller 640 may synchronize the operations of the temperature sensing control unit 644 with the pulse timing control unit 642.
In one embodiment, the pulse timing control unit 642 and the temperature sensing control unit 640 may comprise one or more of software, firmware, or other programming code operating in the controller 640. In one embodiment, the pulse timing control unit 642 and the temperature control unit 644 may comprise separate processors or sub-processors within controller 640. A wide variety of hardware and software designs may be used to achieve the functions described herein, and all are considered as within the scope of the present disclosure.
Controller 640 may also control other operations within the therapeutic laser treatment system 600 (e.g., software and firmware units and subunits, timers, mechanical or electrical elements or subsystems, etc.). These functions may also include, without limitation, control of the positioning of scanner 634 and thus the location within the cooling window 628 of the target skin areas. Controller 640 also controls the operation of cooling system 622, including without limitation the temperature at which the cooling window is maintained (which may be determined by a user or by the patient's skin type as described in connection with
A user interface 650 allows a system user to select or program one or more parameters (e.g., beam diameter or spot size, fluence, wavelength, target temperature of the surface of the target skin area, cooling temperature of the target skin area at which a pulse may be delivered, etc.) to direct the operation of the therapeutic laser system 600. User interface 650 also displays various status indicators and data to the user associated with the system and/or a treatment session, such as the current laser parameters, duration of treatment, number of pulses delivered, etc. Controller 640 may also receive and process inputs from the user interface 650, and may provide outputs to the user interface as well.
Finally, the system 600 includes a power supply 660 for providing power to one or more of the foregoing portions of the system. In one embodiment, power supply 660 may comprise a power supply coupled to a standard NC power outlet to convert AC to DC power at one or more voltages, and may include a battery (e.g., for backup in the event of a power outage), a supercapacitor, etc. Power supply 660 also provides power to controller 640, which in turn includes a current-controlled power supply for driving the diode laser 610 and/or other system components and subassemblies at rapid switching rates based on inputs from pulse timing control unit 642, temperature sensing control unit 644, cooling system 622, temperature sensor 24, and scanner 634.
The system of
Controller 640 includes a skin type determination unit 646 that receives data from the skin typing light sensor 638 relating to, e.g., the absorbance or non-absorbance of the patient's skin of particular wavelengths of light from the skin typing light source 636. The skin type determination unit 646 analyzes the absorbance/non-absorbance data from the skin typing light sensor 638 and determines a skin type of the patient. Controller 640 includes logic (not shown) to modify one or more aspects of the laser treatment based on the patient's skin type for the purpose of maintaining the skin surface temperature below a desired maximum surface temperature during treatment.
Without being bound by theory, patients with darker skin (i.e., a higher melanin content than lighter skin) may experience a more rapid temperature rise during the delivery of a laser pulse as relatively more energy from the pulse is absorbed by the more highly concentrated melanin particles in the skin. To avoid an excessive temperature (and an increased risk of patient discomfort and/or pain), controller 640 may, for example, provide additional cooling (i.e., longer cooling time) for patients with darker skin prior to applying a laser therapy; lower a target skin temperature at which a therapy pulse is initiated (e.g., initiate therapy when the skin is cooled to 5° C. for patients with darker skin instead of 10° C. for lighter-skin patients); lower a fluence of the therapeutic laser pulses to deliver less energy per unit time for darker skin patients; lower a peak power of the laser pulses of a laser therapy for darker skin patients. The controller may also modify or change other parameters such as laser pulse duration and laser spot size to ensure efficacious surface temperature control in the treatment of a wide range of skin types.
Handpiece 700 also includes a thermoelectric cooler 750, which includes a heatsink portion 752 in contact with cooling window 710 to maintain the cooling window at a desired (e.g., programmed) temperature during contact with the first skin area. In one embodiment, cooling window 710 cools the first skin area from a first surface temperature (e.g., body temperature) to a second surface temperature before laser pulses 720 are applied to the skin. In one embodiment, the target skin area is cooled before, during, and after application of a laser pulse thereto.
Skin temperatures may be detected by infrared energy radiated from the skin through the cooling window 710. This infrared energy is reflected by scanner 760 onto temperature detector mirror 780, which focuses the infrared energy on a detection element (not shown) that enables a processor to determine the temperature of a target skin area based on the infrared energy from the detector mirror 780. Temperatures of a target skin area may be determined at a desired sampling rate as previously noted.
In some embodiments (not shown), a handpiece may be omitted entirely, and temperature-controlled delivery of a therapeutic pulse to a target skin area may be performed with other structures to deliver the laser pulse.
The method of
Referring again to
In preferred, embodiments, a plurality of surface temperature determinations are made during the delivery of the pulse. From the plurality of surface temperature determinations, a linear or polynomial fit to the temperature data may be used to determine a rate of increase of the skin temperature caused by the delivery of the laser energy to the target skin area. In one embodiment, the line or polynomial may be used to identify a future timepoint at which a desired temperature will be reached.
Finally, the method of
Referring again to
Finally, the method includes terminating the application of the therapeutic laser pulse to the target skin area at a second timepoint based at least in part on the at least one surface temperature determination (1050). In different embodiments, the second timepoint may comprise a timepoint at which a temperature determination indicates that the surface skin temperature of the target skin area has reached or slightly exceeded a desired second temperature, or a timepoint predicted from a linear or polynomial fit to prior temperature determination data as discussed above.
The method further comprises determining, prior to initiating the application of a therapeutic laser pulse to the target skin area, a surface temperature of the target skin area a plurality of times during the cooling of the target skin area, based on infrared energy radiated from the target skin area through the cooling window (1130). As discussed in connection with
Referring again to
After the therapeutic laser pulse is initiated, the method comprises determining a surface temperature of the target skin area at least once during the application of the therapeutic laser pulse, based on infrared energy radiated from the target skin area through the cooling window (1150). In preferred embodiments, a plurality of surface temperature determinations is made during the delivery of the therapeutic laser pulse.
Finally, the method includes terminating the application of the therapeutic laser pulse to the target skin area at a second timepoint based at least in part on the at least one surface temperature determination during the application of the therapeutic laser pulse (1160). In different embodiments, the second timepoint may comprise a timepoint at which a temperature determination indicates that the surface skin temperature of the target skin area has reached or slightly exceeded a desired temperature, or a timepoint predicted from a linear or polynomial fit to prior temperature determinations made during the delivery of the therapeutic laser pulse.
In one aspect, the invention comprises methods of treating a patient by controlling the duration of a laser pulse without a required cooling step.
In one aspect, the invention comprises methods of treating a patient by initiating a therapeutic laser pulse when the skin has been pre-cooled to a desired temperature.
In various embodiments, the present invention relates to the subject matter of the following numbered paragraphs.
101. A method of controlling a duration of a therapeutic laser pulse to the skin of a patient, the method comprising:
initiating, at a first timepoint, the application of a therapeutic laser pulse to a target skin area of the patient;
determining a surface temperature of the target skin area at least once during the application of the therapeutic laser pulse based at least in part on infrared energy radiated from the target skin area; and
terminating the application of the therapeutic laser pulse to the target skin area at a second timepoint based on the at least one surface temperature determination.
102. The method of claim 101, further comprising:
applying a contact cooling element comprising a cooling window to a first skin area proximate to the target skin area; and
cooling at least the target skin area from a first surface temperature to a second surface temperature.
103. The method of claim 102, wherein the cooling window comprises a material selected from sapphire, ZnS, diamond, ZnSe, and a different thermally conductive material that is transmissive to infrared light.
104. The method of claim 102, wherein the step of cooling at least the target skin area to the second surface temperature is performed prior to initiating the application of the therapeutic laser pulse to the target skin area.
105. The method of claim 102, wherein cooling at least the target skin area comprises cooling the cooling window using a cooling medium selected from the group consisting of water, a halogenated hydrocarbon refrigerant, and air.
106. The method of claim 102, wherein cooling at least the target skin area comprises cooling the cooling window using a thermoelectric cooler.
107. The method of claim 101, further comprising cooling at least the target skin area from a first surface temperature to a second surface temperature.
108. The method of claim 107, wherein cooling at least the target skin area comprises cooling at least the target skin area, prior to initiating the application of the therapeutic laser pulse, from a first surface temperature of body temperature to a second surface temperature within the range of −10° C. to 20° C.
109. The method of claim 107, wherein cooling at least the target skin area comprises cooling at least the target skin area, prior to initiating the application of the therapeutic laser pulse, from a first surface temperature to a second surface temperature within the range of −5° C. to 10° C.
110. The method of claim 107, wherein cooling at least a target skin area comprises cooling the surface of the target skin area, prior to initiating the application of the therapeutic laser pulse, from a first surface temperature to a second surface temperature within the range of −5° C. to 5° C.
111. The method of claim 107, wherein cooling at least the target skin area comprises one of
cooling the target skin area from the first surface temperature to the second surface temperature prior to initiating the application of the therapeutic laser pulse; and
cooling the target skin area from the first surface temperature to the second surface temperature after terminating the application of the therapeutic laser pulse.
112. The method of claim 107, wherein cooling at least the first target skin area from a first surface temperature to a second surface temperature comprises cooling the target skin area to the second surface temperature prior to initiating the application of the therapeutic laser pulse, the method further comprising
cooling the target skin area from a third surface temperature to a fourth surface temperature after terminating the application of the therapeutic laser pulse.
113. The method of claim 112, wherein the third surface temperature is user-selectable.
114. The method of claim 112, wherein at least one of the third surface temperature and the fourth surface temperature is user-selectable.
115. The method of claim 101, further comprising:
determining the pulse duration of the therapeutic laser pulse as the difference between the first and second timepoint;
applying a subsequent therapeutic laser pulse to the of controlling a duration of a therapeutic laser pulse to the skin of a patient, the method comprising:
initiating, at a first timepoint, the application of a therapeutic laser pulse to a target skin area of the patient;
determining a surface temperature of the target skin area at least once during the application of the therapeutic laser pulse based at least in part on infrared energy radiated from the target skin area; and
terminating the application of the therapeutic laser pulse to the target skin area at a second timepoint based on the at least one surface temperature determination.
116. The method of claim 101, wherein determining a surface temperature of the target skin area at least once during the application of the therapeutic laser pulse comprises determining a surface temperature of the target skin area a plurality of times during the application of the therapeutic laser pulse at a predetermined temperature sampling time interval of 100 msec or less.
117. The method of claim 116, wherein the predetermined temperature sampling time interval is a time interval within the range of 0.01-10.0 msec.
118. The method of claim 101, wherein initiating the application of a therapeutic lase pulse comprises initiating a laser pulse at a power density of at least 100 W/cm2.
119. The method of claim 101, wherein initiating the application of a therapeutic laser pulse comprises initiating a laser pulse having an energy fluence of at least 2 J/cm2.
120. The method of claim 119, wherein the therapeutic laser pulse has an energy fluence within the range of 2-100 J/cm2.
121. The method of claim 120, wherein the therapeutic laser pulse has an energy fluence within the range of 2-40 J/cm2.
201. A method of treating the skin of a patient with a therapeutic laser pulse, the method comprising:
a) applying a contact cooling element comprising a cooling window to a first skin area of the patient;
b) cooling at least a target skin area within the first skin area from a first surface temperature using the contact cooling element;
c) determining a surface temperature of the target skin area a plurality of times during the application of the contact cooling element to the first skin area, wherein each of said surface temperature determinations is based on infrared energy radiated from the target skin area through the cooling window prior to initiating the application of a therapeutic laser pulse to the target skin area;
d) initiating the application of a therapeutic laser pulse to the target skin area through the cooling window at a first timepoint based at least in part on one or more of the plurality of surface temperature determinations of the target skin area.
202. The method of claim 201, further comprising:
e) determining a surface temperature of the target skin area at least once during the application of the therapeutic laser pulse, based on infrared energy radiated from the target skin area through the cooling window; and
f) terminating the application of the therapeutic laser pulse to the target skin area at a second timepoint based on the at least one surface temperature determination.
301. A method of treating the skin of a patient with a therapeutic laser pulse, the method comprising:
a) cooling a target skin area of the patient from a first surface temperature;
b) determining a surface temperature of the target skin area a plurality of times during the cooling of the target skin area, wherein the determining is based on infrared energy radiated from the target skin area;
c) initiating the application of a therapeutic laser pulse to the target skin area when the determining indicates that the target skin area has been cooled to a second surface temperature.
302. The method of claim 301, further comprising:
d) determining a surface temperature of the target skin area a plurality of times during the application of the therapeutic laser pulse to the target skin area, wherein the determining is based on infrared energy radiated from the target skin area.
303. The method of claim 301, further comprising:
d) characterizing the patient's skin; and
e) determining a target second surface temperature based on the characterizing.
304. The method of claim 303, wherein characterizing the patient's skin comprises determining a melanin content of at least a portion of the patient's skin, and wherein determining a target second surface temperature comprises selecting a lower target second surface temperature the higher the patient's melanin content.
305. The method of claim 303, wherein characterizing the patient's skin comprises determining a Fitzpatrick score indicative of the skin type of the patient, and wherein determining a second target surface temperature comprises selecting a lower target second surface temperature for higher Fitzpatrick scores.
The particular embodiments disclosed and discussed above are illustrative only, as the invention may be modified and practiced in different but equivalent manners apparent to those skilled in the art having the benefit of the teachings herein. Embodiments of the present invention disclosed and claimed herein may be made and executed without undue experimentation with the benefit of the present disclosure. While the invention has been described in terms of particular embodiments, it will be apparent to those of skill in the art that variations may be applied to systems and apparatus described herein without departing from the concept, spirit and scope of the invention. Examples are all intended to be non-limiting. It is therefore evident that the particular embodiments disclosed above may be altered or modified and all such variations are considered within the scope and spirit of the invention, which are limited only by the scope of the claims.
This application is a continuation of and claims the benefit of priority to U.S. patent application Ser. No. 16/805,761, filed Feb. 29, 2020, entitled “Systems and Methods for Controlling Therapeutic Laser Pulse Duration,” now U.S. Pat. No. 10,864,380, which is incorporated by reference herein in its entirety.
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| Number | Date | Country | |
|---|---|---|---|
| 20210268305 A1 | Sep 2021 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16805761 | Feb 2020 | US |
| Child | 17120159 | US |
