As discussed, the predominant adverse effect associated with current laser devices is thermally mediated. It follows that cooling or precooling the skin has been suggested as an approach to reduce tissue damage associated with laser treatment [176], especially where melanin is the primary target chromophore. Precooling can be accomplished in several ways. The design of the laser may be such that contact with the skin either cools the skin or may act as a heat sink [177-180]. An actively cooled sapphire tip has been used on several laser hair removal systems to provide heat conduction from epidermis before, during, and after each laser pulse. For treatment, the hand piece is placed on the skin for about
0. 5 seconds to cool the surface (epidermis can be cooled in 0.2 seconds) before a laser pulse is fired. Cryogenic sprays are used commonly in laser treatments to reduce thermal injury [180-187]. Cool air [188,189] has been used with success. A recent report, however, found an increase in postinflammatory hyperpigmentation in Asian skin that was attributed to the use of super-cooled air, used in combination with Nd:YAG [190]. However, it is generally accepted that cooling allows higher laser fluence to be delivered, which is important when treating the deeper dermal targets such as hair follicle, while effectively protecting the skin and reducing adverse events.
Other measures used to manage dermal events including, erythema, and skin inflammation and swelling resulting from laser treatment include the use of ice packs and topical corticosteroids. Patients are also instructed to avoid excess sun exposure and trauma, for example, scratching the treatment area, to diminish the likelihood of damaging the skin.