Laser Review Flashcards
(109 cards)
1
Q
Signs of BDD? What should you do if your upset pt has BDD?
A
- Has inspo pictures of Hollywood stars
- Worries about their appearance > 1 hour a day
- No longer has friends or social life
- Directs the Dr or esthetician on how to do procedure
- Has edited pictures of how they want to look
- Knows exactly hoe to solve the problem
- Concerns are difficult for others to see
- Pt tends to be unhappy with results
- Threat of legal action
- Threat of bodily harm to technician, physician, or aesthetician
- Notify doctor
2
Q
How do you treat BDD?
A
therapy and/or meds
3
Q
General characteristics of acne
A
- Can be disfiguring, cause redness, pustules, and scarring
- Not contagious or life threatening but can affect self esteem
- One of the primary concerns of aesthetic clients
4
Q
What are the causes of acne?
A
- Not to do with cleanliness; is hereditary or hormonal
- Hereditary factors known as retention hyperkeratosis = dead skin (keratinocytes) doesn’t shed off the surface of the corneum and instead build up in the follicle (tendency for heavy sebum or oily skin is also hereditary); Sebum waxes over cell build up and causes irritation and inflammation of the follicle = acne
5
Q
How does oil make you acne prone?
A
- Oiliness can cause enlarged pores
- Oil and build up can plug pores
6
Q
What bacteria is responsible for acne and what does it feed on?
A
- P acnes (propionibacterium acnes)
- It can’t survive w oxygen
- in normal skin oxygen is present and kills p acnes; in acne prone skin oxygen is blocked and allows p acnes to thrive off of sebum
7
Q
What are comedones? Types?
A
- non inflammatory acne lesions
- open and closed
8
Q
What is the difference between open and closed comedones?
A
- closed are whiteheads
- open are blackheads
9
Q
What is inflammatory acne/ acne papule? What causes it?
A
- Acne characterized by redness and inflammation
- pressure builds on the follicle walls and the wall ruptures –> spread of bacteria, sebum, and debris –> debris is detected by the dermal immune system –> skin around the lesion and follicle become red and inflamed as WBC are recruited
- in acne, pus rises, forming a clump at the top of the follicle = pustule
10
Q
Difference between papule and pustule?
A
- Papule is a red, inflamed lesion without a white center
- Pustule is a raised, red lesion with a white center
11
Q
What is a nodule?
A
- deeper lesion that can be felt and moved around easily under the skin
- too deep for surface treatments
12
Q
What is a cyst? how is it formed? What can happen as a result?
A
- deep pockets of infection with large amounts of pus
- formed when the skin forms hardened tissue around infection to try to stop the spread
- can destroy dermal cells causing depressed or raised scars
- too deep for surface treatments
13
Q
What are sebaceous filaments? where are they usually found? how to treat?
A
- clogged pores/small impacted follicles
- found in T zone
- responds well to peels
14
Q
How is acne related to hormones in teens?
A
- Androgens (DHT) stimulate sebaceous glands –> increase sebum production –> increased follicle inflammation and causes follicle wall to stretch
- starts with puberty (11-12 yrs); nose, then forehead, then chin
- follicles in children are hard to see and become more visible with puberty
- Teen acne is moe prominent in males
15
Q
How is acne related to hormones in adults?
A
- females more likely to get adult acne d/t hormonal fluctuations (birth control, pregnancy, lactation, menopause, HRT)
- Premenstrual acne (8-10 days prior to period) = increased sebum production = perifollicular inflammation
- Large sore papules around jawline, chin, and neck, and other areas
16
Q
Other factors that affect acne?
A
- Diet: food has little to do with acne; there is no scientific evidence to back it up
- Stress: adrenal gland responds to stress by releasing adrenaline which helps people cope with stressful events. Follicles become inflamed with the overproduction of sebum
17
Q
What are two treatments for acne?
A
Accutane and photodynamic therapy
18
Q
What is accutane? How does it work? how long do results last?
A
- Oral retinoid used to treat severe inflammatory and cystic acne
- Only drug that causes sebaceous glands to shrink and normalize
- Normalizes the hyperkeratosis (thickening) of the follicle
- Mode of action: increases lipids in the blood
thus Patients must have liver and kidney function monitored regularly
-After stopping Accutane the results last for several months; skin will become less dry and some sebum production will resume
19
Q
What are the medical and aesthetic side effects of accutane?
A
- bone and tendon calcification
- Severe birth defects therefore women of childbearing age have to also use birth control
- Mental disturbance with an increased suicide risk (mostly concerning teens)
- Aesthetic side effects = red, sensitive, and dry skin; dehydration and flaking
20
Q
What specific products should those on accutane be using?
A
- mild, nonfragranced, non exfoliating, nonfoaming/low foaming cleanser
- Nonalcoholic, hydrating toner
- Hydrating, nonfragranced and noncomedogenic moisturizer
- Nonfragranced, noncomedogenic, alcohol free SPF 30 (min)
- Azulene and green tea extract reduces redness and soothes skin
21
Q
Instructions for those on accutane
A
- Clients on Accutane should stop all exfoliating and keratolytic products (anything that peels the top layer of the skin) — benzoyl peroxide, sulpha, salicylic acid, retinol, AHA, etc
- Wait 12 months before resuming any treatment (confirm with dermatologist)
- Resume treatment with extreme caution
22
Q
What is photodynamic therapy? what are the indications? Benefits?
A
-Treatment performed with Levulan (5-aminolevulinic acid), a photosynthesizing agent, activated with the correct wavelength of light
- Indications: acne, rosacea, sun damage, pigmentation, fine lines
(ARSPF)
- Attacks acne bacteria, minimizes pores and acne scarring, reduces oil glands, removes sun damaged precancerous areas and actinic keratoses
23
Q
What are the contraindications to PDT?
A
- Those with hx of cold sores should start antiviral treatment a day before
- Avoid acid topical treatments or facials for 5 days prior to treatment
- Must be off oral abx for 1 week prior to
- Cant be pregnant or breastfeeding
- Okay to do on a mild tan
24
Q
What is the post treatment for PDT?
A
- For discomfort and swelling —> ice packs
- For cooling (decrease burning sensation) —> vinegar compress (1 tsp to 1 cup cold water for 20 min q 4-6h - ice can be applied over the vinegar soak), Pat dry after vinegar soak and apply 1% hydrocortisone
- Stay inside for at least 24h after
- Advil/Tylenol may be taken as needed
- Photosensitivity to sun is usually gone 24h after but can last up to 40h
- Skin may appear red with some peeling for 2 days after treatment; temporary swelling of lips and eyes; area may be red for 4-6 weeks post treatment
25
PDT protocol
- Cleanse skin
- Apply acetone (4 swipes w gauze)
- Break 2 glass ampules in Levulan stick - shake for 2 min
- Apply solution on entire area (at least 2 coats); important to get to the eyes as it will be apparent that they were not treated
- Allow it to incubate for 30-60 min
- Activate w Blu-U light for 8 min to start
- Wash face well with soap and water to remove residual Levulan
- If little reaction noted on first treatment, increase incubation for next treatment
- Advise patient to come prepared with hat, scarf, and sunglasses as this must be worn when leaving the office
- Photography should be done prior to every treatment
* * safe for all; be cautious for 4-6
26
Where does melanoma show up usually?
tongue, palms, soles
27
What increases your risk of melanoma?
- one bad sunburn before 18yrs, fair skin and red hair, > 50 moles, immunosuppression, fam history of skin cancer
28
What is law in Australia
to send children to school with sunscreen
29
What is UV divided into?
UVC (100-280 nm) = short wavelength; most damaging; completely filtered by the atmosphere and doesn’t reach earth
UVB (280 - 315 nm) = medium wavelength; can’t go past superficial skin layers; responsible for delayed tanning and burning; enhances aging and promotes skin cancer; most is filtered
UVA (315-400 nm) = longest wavelength; 95% of radiation that reaches earth; can penetrate into the deeper layers of the skin and is responsible for immediate tanning; also contributes to aging and skin cancer development
30
Why do Canadians still have such a high skin cancer rate?
people only use sunscreen with intense exposure
31
What is UV index? Daily UV forecast?
- Measure of the intensity of the suns rays
- Scale runs from 1-11 in Canada, but can reach 14 in the US and tropics
- Daily UV index forecast = prediction of max UV strength (usually peaks early afternoon)
32
What is the most common type of skin cancer in Canada? most or least dangerous?
basal cell carcinoma
| - least dangerous
33
Where does BCC appear? What are the EWS?
- Usually appears on sun exposed skin (face, neck, trunk legs); appearance can vary
- Early Warning Signs = small red (d/t small blood vessels), scaly patch; any sore that doesn’t heal within 4 weeks; a firm, flesh coloured or slightly reddish bump with a pearly border; a sore/pimple like growth that bleeds, crusts over, the reappears
34
What causes BCC? and who's at risk?
- UV radiation form the sun is the main cause; frequent severe sunburns and intense sun exposure in childhood increase risk
Who’s at risk?
- Fair skin with blonde or red hair, skin that usually burns, older age (> 50), more men than women, those who've already had it, immunocompromised
35
How is BCC treated?
- Can be surgical excision, curettage, electrodesiccation and cautery, laser, photodynamic therapy and immune modulating creams are on the horizon
- For large tutors and those near important structures, Mohs surgery is indicated (removes just the tumour and spares normal skin)
36
How do you check for moles?
A: Asymmetry
Compare one half of the growth to the other. Unequal or asymmetric are sus
B: Border
Moles should be round or oval. If irregular/indistinct this is sus
C: Colour
Moles should be one colour. Variations and mixtures of colours are sus. Different shades of browns, blues, reds, whites, and black are concerning. A black mole, even one colour, is concerning
D: Diameter
Any mole larger than 6 mm or pencil eraser is sus
E: Elevation or Evolving
Elevated/raised from the skin is sus
Other dangerous signs = changing colour, size, shape, elevation, surface texture, surrounding skin, sensation
37
What are antioxidants? What is considered an antioxidant?
vital phytochemicals/vitamins that prevent/slow oxidative damage (from sun, stress, pollution, metabolic byproduct, and can cause cancer, aging, other disease)
Vit A, C, E, beta carotene
veggies, fruits and nuts, herbs
38
What is laser safety? Why is it needed? What was put in place to regulate them?
- Laser safety = safe design, use, and implementation of lasers to minimize risk of laser accidents
- Moderate and high power lasers are potentially hazardous as they can burn the retina or skin. Some are so powerful that even the reflection from a surface can be hazardous to the eye (The coherence of laser light and the focusing mechanism of the eye = concentration of laser light into a small spot on the retina). Infrared lasers are particularly hazardous, since the body’s protective blink reflex is only triggered by visible light (eg. Nd:YAG emits 1064 nm invisible radiation so there is no immediate pain or damage noticed; a pop or click from the eye may be the only indication that damage has occurred)
- To control injury risk, various specifications define classes (4) of laser depending on their wavelength and ability to cause harm
These regulations also have required safety measures
39
What is MPE? how is it measured?
- maximum permissible exposure (MPE) is the highest power or energy density (J/cm square) of a light source that is considered safe
- Measured at the cornea of the human eye or at the skin, for a given wavelength and exposure time
40
which lasers transmit to the retina and which don't?
- Lasers that dont transmit to the retina are CO2, ER:Yag, Ho:Yag; but they can
- All of the visibly coloured lasers and most infrared will transmit back to the retina (Ruby, Alex, Nd:Yag, IPL)
41
What PPE should be worn with lasers? Precautions?
- Protective goggles with appropriate filtering optics for technician and pt
- Also consider: clothing, surfaces/windows/mirrors, calibration, maintenance, manufacturer's instructions
- don't stare into laser beam, don't take deep breath of laser plume
- don’t perform in a room with mirror, remove jewelry near the treatment area, a laser sign must be outside room, laser key must be removed from machine after use
42
What is laser? purpose?
- light amplification by the stimulated emission of radiation
- direct beam of light
- cut, vaporize, coagulation, ablation
43
Frequency
the numbers of waves to pass a single point
44
Wavelength
distance between he peak of one wave to the peak of another
45
What is the relationship between frequency and wavelength? which is good for dark skin?
inverse
| longer wavelength good for darker skin, shorter for light skin
46
What is the EM spectrum?
- tool used to measure the entire range of light made by EM energy
- Invisible (UV) --> 190 - 390 nm
Visible --> 400 - 700 nm (high absorption, low energy)
Infrared --> 760 - 1000 nm (low absorption, high energy)
47
What is EM energy?
released when an electrical charge is accelerated by an external force
48
How do lasers work? what do they consist of?
electron in an atom of an optical material gets excited by electricity or light; they move to a higher energy orbit; then when it returns it releases photons
1. active medium
2. optical resonator
3. microprocessor
4. delivery system
5. cooling system
6. power supply
49
Whats the difference between visible and invisible light?
```
visible = multiple wavelengths and incoherent
laser = coherent (all together and in the same direction), monochromatic (a single wavelength and colour), collimated (parallel photons)
```
50
chromophore? types?
part of the molecule that is responsible for the colour. target for the laser
blood, protein, collagen, pigment, water
51
optical resonator
holds active medium
52
active medium
part of the laser that absorbs and stores energy
- gas (Co2, helium, argon)
- solid (synthetic crystal)
- liquid (organic liquid or dye)
53
selective photothermolysis?
Thermal energy created by light is absorbed by. specific chromophore by setting wavelength, pulse duration, exposure time and power
54
cooling
precooling, parallel cooling, post cooling
contact -- conducts heat from the skin to the cooling device or substance placed onto the skin (active = copper/sapphire; inactive = ice/cold gel)
non contact -- conducts heat from the skin via evaporation or convection (cooling spray, oxygen)
55
fluence
power or energy density of the laser. Amount of energy in contact with skin per cm square
56
pulse duration
the duration of a single pulse of light is in contact with skin
57
hertz
the speed at which a single pulse of light is delivered (cycles per second)
58
thermal relaxation time
time to heat up a target but not destroy tissue
59
Ultraviolet
radiation we can't see
60
infrared
made of all forms of energy whose spectrum extends fro along radio waves to ultra short game rays we can't see
61
photons
unit of light
62
nanometer
billionth of meter
63
micrometer
millionth of a meter
64
joules
unit of energy
65
spot size
width of the laser beam
66
absorption
uptake of one substance into another
| - causes ablation of material
67
reflection
beams reflect off of shiny surfaces and damage skin surfaces
68
transmission
laser can be transmitted through glass, liquid, tissue
69
melanin
pigment of the skin, hair, eyes and protects skin from UV damage
70
Scatter
the deeper the transmission, the more the scatter
71
Hair anatomy? follicle, shaft, bulb, papilla, oil ducts
- made of keratin; colour dependent on melanin
Follicle = mass of epidermis that extends into the dermis and forms tube around the shaft
shaft = visible portion of hair above the scalp
bulb = swelling at the base of follicle that provides hair with nourishment
papilla = in the bulb. has cells and BV the provide growth and nourishment
oil ducts = attached to the follicle that lubricates the hair
72
Hair growth stages
Anagen (growth) = new keratinized cells created as bulb moves into the dermis. thick shaft, increased melanin
Catagen (regression) = shaft grows upward with eventual loss of bulb. separates from papilla
telogen (resting) = hair falls out and bulb moves up to restart cycle
73
what can Fitzpatrick 1 tolerate
has the least melanin therefore will absorb the least heat and can tolerate highest energies
74
LHR client assessment?
general health, hair type, growth pattern, colour, fam hx of hair growth, skin type, previous hair removal techniques, menstrual cycle, hx of scarring infection herpes, tanning
75
Why shouldn't you tan 72h before LHR?
- sun makes skin more sensitive to heat, and laser on heat sensitive skin can cause hyper-pigmentation, burns and even scarring
- also can make skin darker, so if skin has increased melanin it's difficult for the laser to distinguish between hair and skin.
76
LHR indications?
hypertrichosis, hirsutism, unwanted hair, pseudo folliculitis barbae
77
LHR contraindications
villus hair, albinism, vitiligo, recent tan/sun exposure, recent hair removal expect for shaving in last 6-10 weeks, herpes, open sores; infection; suspicious lesion, tattoos, pregnant/breastfeeding; photosensitive meds,
78
Basic procedure
- review client hx/ medical review
- assess skin (make sure its intact/tanning)
- Fitzpatrick
- review treatment, goals, and consent
- prophylactic antiviral for cold sores (if treating face)
- shave if hair present, protect tattoos, eye protection, clean with alcohol
79
LHR desired outcomes
smudging, popping, hair smell, perifolllicular deem, mild erythema, sunburn sensation
80
LHR post treatment
- no sun exposure for 1 month post; no sauna/hot tub/ steam room/ hot bath for 72h; no acids or retinoids for 72h post; no hair removal aside form shaving between appointments, SPF 30 min, cooling (cold pack, ale, soothing gel), hair may appear darker or coarser and take 2 weeks to shed (don't pick or squeeze), for the armpit (no deodorant or antiperspirant immediately after)
81
Possible LHR side effects
folliculitis w excessing sweating/swimming, hair growth stimulation, hyper/hypo pigmentation, blistering, scarring
82
Diode laser
- most efficient light source available; smaller than lfashlamp devices
- 800 nm near infrared, 2-3 mm deep
- good melanin absoprtion
- less risk of post treatment pigmentary changes
83
Nd Yag
- 1064 nm; 3-5 mm deep
- less melanin absorption than seen with visible light
- Is safe to treat darker complexion
- Safe and effective results can be produced in Fitzpatrick VI
84
What is IPL? How does it work? What is it used for? common areas?
- noninvasive, non laser induced selective photothermolysis
- delivers non coherent light between 515- 1200 nm in synchronized pulses separated by short TRT intervals for protection of epidermal melanin
filters are used to choose wavelength
- hair removal, vascular lesions, skin rejuvenation
- common areas = face, neck, hands, chest
85
Which Fitzpatrick can use IPL?
1-4
86
which skin needs shorter or longer pulse duration and interpose time for IPL?
darker skin needs longer pulse duration and longer interpulse time
87
What is the purpose of cooling?
- reduces discomfort, minimizes thermal injury
88
IPL contraindications?
- Current hx of cancer (especially skin cancer)
- Active infections, cold sores, HIV/AIDs
- Photosensitive drugs
- Hormonal or endocrine disorders, Bleeding disorder
- Keloid
- Very dry skin
- Hx of sun exposure or tanning in last month
- Skin type V or VI
- Pregnancy or breastfeeding
- Recent retina A or chemical peels
- Melasma
89
What does IPL treat?
- photo damaged skin
- Benign pigmented lesions(hyperpigmentation, scars)
- Benign vascular lesions (port wine, hemangioma, telangiectasias, rosacea, angiomas, poikiloderma)
90
IPL expectations/benefits?
- little to no downtime
- may be some discomfort or pain during the treatment —> can use cooling device
- may have darker pigment that will shed up to 14 days after
- can experience transient redness and swelling during
- social downtime (can cover with makeup)
91
What is the IPL treatment plan?
Treatment plan = 4-6 treatments should be planned; 3-4 weeks apart
92
Possible IPL side effects?
- Discomfort—> stinging or rubber band snapping; burning may last for up to 1h after
- Damage —> a crust or blister may form (may take 5-10 days to heal)
- Pigment —> Hypo/hyperpigmentation in people with darker skin or exposed area
- Hyperpigmentation can occur despite sun protection (usually fades in 3-6 months)
- Scarring —> small chance of scarring
- Swelling—> immediately after (nose and cheeks) may swell temporarily which subsides within hours to 7 days
- Fragile skin —> if this happens avoid makeup and don’t rub the skin
- Bruising —> very rare, may appear and last 5-15 days; as bruise fades there may be a rust/brown colour which fades in 1-3 months
93
IPL technique facts?
- Preoperative shaving reduces treatment induced odour, and prevents hairs lying on the skin from conducting thermal energy of the skin
- Epidermal cooling should be used for safety
- Treated hairs sometimes appear darker after and usually fall out 1-4 weeks after
- When treating darker complexion, take several test pulses at an inconspicuous site with a lesser fluence
- Eye protection —> all people into room need to wear to protect from retinal damage (if treating near the eyes, patient must wear opaque protective eyewear)
- Topical anaesthesia —> due to low energy can be done without topical anesthesia. Treatments in large areas may prefer it (4% lidocaine recommended) EMLA not recommended due to vasoconstriction. Anesthetics usually applied 1h prior to. (Remember to remove all of the topical anesthetic prior to treating)
94
hyperpigmentation
harmless patches of skin that are darker than surrounding skin
95
roasacea
inflammatory redness of the skin( across nose, cheek, chin and forehead)
- develops gradually as mild facial flushing
96
telangiectasia
small dilated or broken BV visible through the epidermis
97
melasma
diffuse, symmetrical hyperpigmentation on the face that appears mostly with hormonal changes
98
poikiloderma
areas of increased or decreased pigmentation, prominent BV, thinning skin
99
age spots
lentingines, freckles, hyperpigmented patches from aging or sun exposure
100
How does IPL treat vascular lesions?
- 515-1200 intense pulsed light for benign cutaneous vascular lesions
- examine lesions for suitability, never treat over hair or tattoo, hair over VL must be removed prior to, multiple treatments may be required over several months
- some pain or discomfort associated with treatment, erythema/edema may appear immediately after
101
hirsutism
excessive hair growth in females in male growth patterns
102
psueoofolliculitis barbae
ingrown hair
103
villus hair
very fine, soft hair found in areas not covered by coarse hair (peach fuzz)
104
terminal hair
hair found on scalp, arm, legs, pubic area, axillae
105
hypertrichosis
excessive hair growth on areas that don't typically grow hair (palms/soles)
106
which area of the body has the most rapid growing anagen phase of the entire body
face and head
107
how often should laser hair treatments be
- for face every 4-6 weeks
- for underarm and pubic area should be every 6-8 weeks
- for legs, every 2-3 months
108
which area is mostly in telogen phae
underarm and pubic
109
which is mostly in anlagen and telogen phase
legs
