CC BY
4DOI 10.24412/cl-37136-2023-1-107-112
INVESTIGATION OF THE INFLUENCE OF THERMALLY-INDUCED METHEMOGLOBIN IN THE SKIN LAYERS ON THE EFFICIENCY OF LASER SCLEROSING OF
TELANGIECTASIAS
ANDREY BELIKOV12, VIKTOR CHUCHIN1,3
institute of Laser Technologies, ITMO University, Russia 2Research Institute of Dentistry and Maxillofacial Surgery, Pavlov First St. Petersburg State Medical
University, Russia 3Sector of Medical Laser Technologies, "NPP VOLO " LLC, Russia
ABSTRACT
Lasers are widely used in dermatology for the treatment of telangiectasias, which are persistent dilation of the dermis blood vessels (venules, capillaries, arterioles) [1]. Blood absorbs electromagnetic radiation in the visible range effectively [2]. The small penetration depth of visible light into the skin is the problem of using visible lasers for sclerosis of the deep telangiectasias, which are not amenable to such treatment. Effective treatment of large telangiectasias requires a high energy density, which causes heating, undesirable damage to the surrounding tissues and increases the healing time [3]. Changing the skin optical properties is necessary to increase the sclerosis efficiency of deep and large telangiectasias with visible laser radiation. There is a known a method for increasing the optical transmission of human blood at certain wavelengths up to 50% by heating it up to 65 °C [4], which may be associated with the transformation of hemoglobin to methemoglobin [5]. We assume to heat the skin locally, achieve maximum increase of the optical transmission, and then perform sclerosis of the pathological vessel with a visible laser pulse.
First of all, it is necessary to develop an adequate skin optical model for a theoretical assessment of the effect of thermally induced methemoglobin on the optical properties of skin and on effectiveness of sclerosis. A seven-layer optical model of the skin is relevant today (Fig. 1): the stratum corneum, the layer of living cells of the epidermis, the papillary dermis, the superficial vascular plexus, the reticular dermis, the deep vascular plexus and the subcutaneous fat [6-10]. The thicknesses of the layers are presented in [6]. The refractive indexes of these layers are given in [11-13]. The stratum corneum and living epidermis absorption coefficients ware calculated using the equations from [8]. The absorption coefficients of other skin layers and whole blood were calculated using the equations from [14], the volume concentrations of chromophores are presented in [8, 1530]. Then, the absorption coefficients were calculated for the case when all hemoglobin was replaced by methemoglobin [31, 32] in the skin layers and whole blood. Methods for calculating scattering coefficients and anisotropy factors are described in [7].
"---_ Stratum comeum " " -——___ Living epidermis __ Papillary dermis
Superficial vascularplexus
Reticular dermis
Deep vascularplexus
Subcutaneous fat
Figure 1: Skin layers in the model
The transport extinction coefficients tr) for both cases (containing hemoglobin and methemoglobin) were calculated for whole blood [33]. The change in optical transmission of whole blood (OT) resulting from the replacement of hemoglobin with methemoglobin was estimated using the equation:
OT =
The wavelengths with the highest and lowest OT values of whole blood were selected for optical simulation. Optical simulation of skin was performed by the Monte Carlo method in the TracePro 7.0.1 (Lambda Research Corporation, USA). Laser exposure was carried out by a 4 mm diameter parallel beam (10,000 rays) perpendicular to the skin surface. The absorbed optical power distributions in skin at selected wavelengths were obtained for both cases for further thermophysical simulation as a volume heat source.
Thermophysical simulation was performed in COMSOL Multiphysics (COMSOL Inc., USA) and was performed by the method of radiative-conductive heat transfer. The values of the thermophysical properties of the skin layers are presented in Table 1. The maximum temperature of skin heating by laser radiation and depth which a temperature of 42 °C (start temperature of the coagulation process) was reached at have been estimated as a result of thermophysical simulation for both cases and compared with each other.
Table 1. Thermophysical properties of the skin layers [34]
Thermophysical property Stratum corneum Living epidermis Papillary dermis Superficial vascular plexus Reticular dermis Deep vascular plexus Subcutaneo us fat
Thermal conductivity, ' i J ) V kg x K J 3600 3800 2250
Density, p J 1200 1200 850
Thermal conductivity, k ( " ) \m x K ! 0.21 0.53 0.19
The results of OT calculations showed that the largest OT growth is observed at 441 nm (OT=1.96) and 574 nm (OT=2.50), and the largest OT reduce - at 629 nm (OT=0.37) and 1105 nm (OT=0.55). The distribution of absorbed optical power in the skin at these wavelengths was obtained as a result of optical simulation.
Heating of the skin with 100% concentration of hemoglobin in the blood by laser radiation at a wavelength of 441 nm with a power of 2 W for 1 s showed a maximum temperature of 113 °C (Fig. 2a). Heating of the skin with 100% concentration of methemoglobin in the blood by laser radiation at this wavelength with same parameters showed a maximum temperature of 103 °C (Fig. 2b) due to a decrease in absorption at this wavelength.
a b
Figure 2: Heating of skin with 100% concentration of hemoglobin (a) and 100% concentration of methemoglobin (b) in the blood by 441 nm radiation Heating of the skin with 100% concentration of hemoglobin in the blood by laser radiation at a wavelength of 574 nm with a power of 2 W for 1 s showed a maximum temperature of 92 °C (Fig. 3a). Heating of the skin with 100% concentration of methemoglobin in the blood by laser radiation at this wavelength with same parameters showed a maximum temperature of 78.8 °C (Fig. 3b) due to a decrease in absorption at this wavelength.
a b
Figure 3: Heating of skin with 100% concentration of hemoglobin (a) and100% concentration of methemoglobin (b) in the blood by 574 nm radiation Heating of the skin with 100% concentration of hemoglobin in the blood by laser radiation at a wavelength of 629 nm with a power of 2 W for 1 s showed a maximum temperature of 53 °C (Fig. 4a). Heating of the skin with 100% concentration of methemoglobin in the blood by laser radiation at this wavelength with same parameters showed a maximum temperature of 70.4 °C (Fig. 4b) due to an increase in absorption at this wavelength.
Figure 4: Heating of skin with 100% concentration of hemoglobin (a) and 100% concentration of methemoglobin (b) in the blood by 629 nm radiation Heating of the skin with 100% concentration of hemoglobin in the blood by laser radiation at a wavelength of 1105 nm with a power of 2 W for 1 s showed a maximum temperature of 44.5 °C, (Fig. 5a). Heating of the skin with 100% concentration of methemoglobin in the blood by laser radiation at this wavelength with same parameters showed a maximum temperature of 58.5 °C (Fig. 5b) due to an increase in absorption at this wavelength. There is a heating zone in the area of the deep vascular plexus.
a b
Figure 5: Heating of skin with 100% concentration of hemoglobin (a) and 100% concentration of methemoglobin (b) in the blood by 1105 nm radiation The results of assessing the heating depth to a temperature of 42 °C (h42) are shown in Figure 6. It can be seen that when hemoglobin is replaced by methemoglobin this heating depth increases at all wavelengths.
■ Skill with 100% concentration of hemoglobin in blood
■ Skm with 100° o concentration of liiethenioglobin in blood 5000 -,-
441 574 629 1105
Wavelength, nm
Figure 6: Comparison of the heating depth to a temperature of 42 °C (h42) at each wavelength For 441 nm and 574 nm, the depth h42 increases due to the decrease in absorption coefficients at these wavelengths in the skin layers. However, for 629 nm and 1104 nm, the depth also increases on the contrary due to an increase in absorption at these wavelengths in the skin layers, which does not allow laser energy to be dissipated over the entire volume of the skin.
The paper considers the possibility of using thermally induced methemoglobin to control the optical properties of a biological tissue. It has been established that methemoglobin in the composition of the skin leads to the greatest growth in its optical transmission at wavelengths near 441 nm and 578 nm and reduce optical transmission at wavelengths near 629 nm and 1105 nm. It has been demonstrated that the hemoglobin to methemoglobin transformation leads to a change in the absorbed optical power in the skin layers and affects the maximum temperature and depth of heating at selected wavelengths. Numerical methods have shown the possibility of using thermally induced methemoglobin to control the optical properties of the skin, which can be used to create laser systems and technologies for the treatment of skin diseases, including laser sclerosing of telangiectasias.
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