title: Effect of dynamic cooling on 585-nm pulsed dye laser treatment of port-wine stain birthmarks.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Laser and Skin Surgery Center of New York, NY 10016, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Waldorf
authors.forename: T S
authors.initials: TS
authors.lastname: Alster
authors.forename: K
authors.initials: K
authors.lastname: McMillan
authors.forename: A N
authors.initials: AN
authors.lastname: Kauvar
authors.forename: R G
authors.initials: RG
authors.lastname: Geronemus
authors.forename: J S
authors.initials: JS
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D005617:Chlorofluorocarbons, Methane; D017679:Cryotherapy / Q000295:instrumentation; D062109:Dermatologic Surgical Procedures; D004817:Epidermis / Q000473:pathology; D004890:Erythema / Q000209:etiology / Q000473:pathology; D006801:Humans; D017495:Hyperpigmentation / Q000517:prevention & control; D017496:Hypopigmentation / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control; D017075:Laser Coagulation / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D019339:Port-Wine Stain / Q000473:pathology / Q000601:surgery*; D012867:Skin / Q000098:blood supply / Q000473:pathology; D012880:Skin Pigmentation; D012881:Skin Temperature; D013057:Spectrum Analysis
chemical_list: D000336:Aerosols; D005617:Chlorofluorocarbons, Methane; C007782:dichlorodifluoromethane