title: Epidermal cooling crystal collar device for improved results and reduced side effects on leg telangiectasias using intense pulsed light.
abstract: BACKGROUND
  Intense pulsed light (IPL), utilizing noncoherent yellow, red, and near-infrared wavelengths can be used to treat telangiectasias. In order to circumvent epidermal heating and allow greater fluence to be delivered safely, a new device that circulates water around the IPL crystal in contact with the skin to provide continuous cooling at 1 degrees C-4 degrees C range was developed.
  
  
  OBJECTIVE
  To observe the effects of contact cooling on IPL treatment of leg telangiectasias.
  
  
  METHODS
  A total of 25 patients were treated using two similar sites of matted telangiectasias on the leg, one site was treated without epidermal cooling and the other with the epidermal cooling crystal collar device. Results were evaluated by comparison with pretreatment photographs at 1 month. At one treatment center, a crossover was performed at the 1-month visit in which the non-E3C site was treated by cooling. Parameters consisted of a 570 nm filter, coupled pulses of 2-2.5 msec/6-7 msec with a 10-msec delay with fluences of 38-40 J. On the site receiving contact cooling the fluence was increased by 10% (4 J/mm2). Sites were graded worse, unchanged, or improved (RAW) or on a numerical scale of 1-4 (NSS).
  
  
  RESULTS
  Compared to the contact cooling sites, uncooled sites showed 7 were improved, 5 were unchanged, and 3 were worsened, but cooled sites showed 10 were improved, 5 were unchanged, and none were worsened (P<.05). The grading scale on 10 patients revealed a mean improvement of 1.7 for noncooled sites and 2.7 for cooled sites (P<.001). For crossover treatment, eight noncooled sites (unchanged or worsened) were subsequently treated with cooling, demonstrating six improved (P<.001) and two with no change. Less erythema and edema was noted at all cooled sites. Furthermore, pain was significantly reduced with cooling (P<.003). Epidermal injury involving hyper- or hypopigmentation, crusting, or vesiculation was not observed in any of the cooled sites, but was recorded in three of the noncooled sites.
  
  
  CONCLUSIONS
  These data indicate that continuous epidermal cooling with IPL allows delivery of higher fluences with less pain and fewer side effects. Efficacy is significantly improved using the coupled short pulse/long pulse protocol. An additional benefit is that IPL treatment becomes less operator dependent because the chilled crystal may be placed directly in contact with the skin.
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. rwderm@home.com
authors.forename: R A
authors.initials: RA
authors.lastname: Weiss
authors.forename: N S
authors.initials: NS
authors.lastname: Sadick
mesh_terms: D004817:Epidermis / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation* / Q000379:methods; D053685:Laser Therapy; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D012881:Skin Temperature; D013684:Telangiectasis / Q000503:physiopathology / Q000601:surgery*