The promises of lasers and light-based technologies

Dr. WheelandThirty years ago, I was asked to give a professional talk at a national meeting about the future of lasers in dermatology. I gave what I thought was a pretty good review of the existing technologies, which were few in number, along with my fanciful (and largely inaccurate) prediction of what dermatologists might see in the development of future devices and what benefits our patients might obtain from them in the treatment of various skin diseases and disorders.

I ended my presentation with the truly outrageous prediction that “every dermatologist would have a laser in their office within 25 years!” I can apologetically say that I really missed the mark on that prediction (unless you give me credit for laser printers and laser pointers). However, I also missed the mark as far as not predicting the future development of safe and effective FDA-cleared over-the-counter lasers and light devices for home use in hair removal, skin rejuvenation and even stimulation of hair growth.

With that background, I have made an effort in writing this editorial not to duplicate my prior predictive errors and instead, stick to technologies that have received regulatory clearance, including some devices - while not in widespread use today - offer intriguing promises for the future.

Education

A good place to start is with the changes that have occurred in educational processes now available for dermatologists to get proper training and hands-on experience with lasers and light-based technologies. 

I was first introduced to laser technology 39 years ago. My mentor was a pediatric ophthalmologist colleague who had a 100 micron beam argon laser that was delivered through a slit-lamp. I worked with the ophthalmologist for a few months and read everything I could get my hands on about the physics of light amplification by Einstein, the treatment of skin disease by the dermatologist Leon Goldman (the “godfather of lasers in medicine”) and, I read everything I could find on laser safety. I now felt reasonably prepared to begin treatments. For two years, I slowly treated adults having vascular lesions found on any anatomic location that could fit on the chin rest of the slit lamp of that argon laser. They obtained reasonable good results. I remember two patients with small port wine stains in anatomic locations that were not conducive to placement on the chin rest of the slit lamp and they had to perform such awkward contortions for treatment, that a chaperone was required.

Fortunately, those days of hit-or-miss learning about lasers are over. Today, every dermatology residency training program in the United States is required to provide instruction on laser physics, safety and appropriate uses. Also, the dermatology board certifying examination demonstrates the importance of this knowledge by including questions on these topics. In addition, courses and lectures on the latest uses of lasers are now part of every annual and summer meeting of the American Academy of Dermatology. Other medical societies, including the American Society for Dermatologic Surgery and the American Society for Laser Medicine and Surgery, also have significant portions of their meetings dedicated to educating dermatologists about safe and appropriate uses for lasers and light sources. There are also many widely available regional smaller courses that offer live patient laser demonstrations.

I’ve created a categorical chronology of

In summary, in the 30 years since I made my last prediction about the future of lasers, a great number of innovations have occurred which improve the quality of care dermatologists can provide their patients with a host of different conditions. While making no predictions, I believe these innovations will continue long into the future.