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Book ChapterDOI

History of lasers in dermatology.

01 Jan 2011-Current problems in dermatology (Karger Publishers)-Vol. 42, pp 1-6

TL;DR: In the 1950s, based on the theory of stimulating radiant energy published by Albert Einstein in 1916, the collaboration of physicists and electrical engineers, searching for monochromatic radiation to study the spectra of molecules, led to the invention of the first laser in 1960.
Abstract: In the 1950s, based on the theory of stimulating radiant energy published by Albert Einstein in 1916, the collaboration of physicists and electrical engineers, searching for monochromatic radiation to study the spectra of molecules, led to the invention of the first laser in 1960. Ophthalmologists and dermatologists were the first to study the biological effects and therapeutic possibilities of laser beams. The construction of new laser systems emitting energy at different wavelengths or with different durations, as well as the development of new concepts of the biomedical effects, led to its broad use in surgery in the treatment of vascular and pigmented lesions as well as cosmetic applications.

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Year:2011
Historyoflasersindermatology
Geiges,ML
Abstract: Inthe1950s,basedonthetheoryofstimulatingradiantenergypublishedbyAlbertEinstein
in1916,thecollaborationofphysicistsandelectricalengineers,searchingformonochromaticradiation
tostudythespectraofmolecules,ledtotheinventionoftherstlaserin1960.Ophthalmologistsand
dermatologistswerethersttostudythebiologicaleectsandtherapeuticpossibilitiesoflaserbeams.
Theconstructionofnewlasersystemsemittingenergyatdierentwavelengthsorwithdierentdurations,
aswellasthedevelopmentofnewconceptsofthebiomedicaleects,ledtoitsbroaduseinsurgeryin
thetreatmentofvascularandpigmentedlesionsaswellascosmeticapplications.Copyright©2011S.
KargerAG,Basel.
DOI:https://doi.org/10.1159/000328225
PostedattheZurichOpenRepositoryandArchive,UniversityofZurich
ZORAURL:https://doi.org/10.5167/uzh-57651
JournalArticle
PublishedVersion
Originallypublishedat:
Geiges,ML(2011).Historyoflasersindermatology.CurrentProblemsinDermatology,42:1-6.
DOI:
https://doi.org/10.1159/000328225

Introduction
Bogdan Allemann I, Goldberg DJ (eds): Basics in Dermatological Laser Applications.
Curr Probl Dermatol. Basel, Karger, 2011, vol 42, pp 1–6
History of Lasers in Dermatology
Michael L. Geiges
Institute and Museum of Medical History, University of Zurich and Department of Dermatology, University Hospital Zurich,
Zurich, Switzerland
Abstract
In the 1950s, based on the theory of stimulating radi-
ant energy published by Albert Einstein in 1916, the col-
laboration of physicists and electrical engineers, search-
ing for monochromatic radiation to study the spectra of
molecules, led to the invention of the first laser in 1960.
Ophthalmologists and dermatologists were the first to
study the biological effects and therapeutic possibilities
of laser beams. The construction of new laser systems
emitting energy at different wavelengths or with different
durations, as well as the development of new concepts of
the biomedical effects, led to its broad use in surgery in
the treatment of vascular and pigmented lesions as well
as cosmetic applications.
Copyright © 2011 S. Karger AG, Basel
It was not predictable that an analytical tool for
physicists to examine the molecular structure of
molecules would become one of the most im-
portant inventions of the 20th century. Theodore
Maiman was enthusiastic about the first laser he
constructed, but regarded it as ‘a solution look-
ing for a problem’ [1]. The expectations during
the Cold War that lasers could be used as pow-
erful weapons remained unfulfilled. Nonetheless,
today laser systems are present in almost every
household, at least in CD players. The accep-
tance of lasers in medicine by doctors as well as
by patients has always been very high. With a
positive attitude towards such a powerful source
of harmless- looking light, lasers became regarded
as magic bullets for the treatment of cancer, re-
placing the bloody knife of the surgeons.
The history of laser is very young and tells of
an invention of great economic value. However,
this makes it very difficult to interpret the differ-
ent references, which are predominantly scientific
papers and autobiographical retrospections of the
people involved. Depending on the intention and
the background of the authors, selection and em-
phasis vary.
Inventing the Laser
In 1916, Albert Einstein discussed the possibil-
ity of stimulating radiant energy based on Niels
Bohr’s theory that atoms emitted energy in quan-
ta when transitioning from excited states back to
resting states [2]. The first experimental proof of
his theory was published by the German physicists
Rudolf Ladenburg and Hans Kopfermann in 1928
[3]. However, stimulated emission received little
attention from experimentalists during the 1920s
and 1930s when atomic and molecular spectros-
copy were of central interest to many physicists
[4]. In 1939, Valentin A. Fabrikant defended his
doctoral thesis, ‘The emission mechanism of a gas

2
Geiges
discharge, at the P.N. Lebedev Physical Institute in
Moscow. It discussed experimental evidence for
the existence of negative absorption (what was lat-
er called stimulated emission) and suggested ex-
periments on light amplification [5].
Although the essential ideas for constructing
a laser were known around 1930, it was not be-
fore the early 1950s that physicists and electrical
engineers began to collaborate with the research
on monochromatic radiation of constant am-
plitude at very small wavelengths studying the
microwave and radio frequency spectra of mol-
ecules. In this context, in 1953 and 1954, sever-
al physicists independently suggested the use of
stimulated emission for microwave amplifica-
tion, creating the acronym MASER to stand for
microwave amplification by stimulated emis-
sion of radiation’ [6].
In 1953, the American physicist Joseph Weber
at the University of Maryland published a pro-
posal for a microwave amplifier that was based
on stimulated emission in a paramagnetic solid
[7]. In 1954, Nikola G. Basov and Alexander M.
Prokhorov of the Lebedev Institute in Moscow and
J.P. Gordon, H.J. Zeiger, and Charles H. Townes
of Columbia University in New York reported on
two molecular devices for generating microwave
radiation, both using the ammonia molecule as
the active species [8, 9].
Charles H. Townes, Nikolay G. Basov, and
Alexander M. Prokhorov received the Nobel Prize
in Physics 1964 for their ‘fundamental work in the
field of quantum electronics which has led to the
construction of oscillators and amplifiers based
on the maser- laser principle’ [10].
The ammonia beam maser itself was not par-
ticularly useful as its operation was limited to
the resonant frequency of the ammonia mole-
cule and could only be used at barely detectable
power levels [1]. In 1958, C.H. Townes and his
brother- in- law Arthur Leonard Schawlow, pro-
fessor at Stanford University, showed that ma-
sers could theoretically be made to operate in
the optical and infrared regions [11]. The same
year, G. Makov, C. Kikuchi, J. Lambe and R.W.
Terhune at the University of Michigan developed
and built a solid- state maser [12]. They used
crystalline corundum (ruby) in a large magnetic
field and a strategy similar to that known as opti-
cal pumping, suggested by Nicolas Bloembergen
at Harvard University in 1956 [13]. Theodore H.
Maiman at the Hughes Corporation Research
Laboratories took over the Kikuchi ruby maser.
In 1960, he presented the first functional optical
ruby maser excited by a xenon flash lamp to pro-
duce a bright pulse of 693.7 nm, deep red light
of about a 1- ms duration and a power output of
about a billion watt per pulse [14]. His invention
rapidly led to the development of multiple other
optical masers, now called laser (light amplifi-
cation by stimulated emission of radiation). In
1961, Fred J. McClung and Robert W. Hellwarth
introduced the quality- switching (Q- switching)
technique to shorten the pulse length to nano-
seconds with the use of an electro- optical shut-
ter that permitted the storage and subsequent re-
lease of a peak power up to gigawatts of energy
[15, 16].
Medical Use of Lasers
The medical specialists who were already treating
diseases with sunlight and technical light sourc-
es were also the first to carry out biomedical re-
search with lasers.
One year after Maiman had presented the first
ruby laser, ophthalmologists using xenon lamps
for retinal photocoagulation published on ocular
lesions experimentally produced in a rabbit by an
optical maser [17]. These studies were soon fol-
lowed by clinical experience on patients treated
for retinal tears, flat detachments, angiomas, and
tumors [18].
In dermatology, the treatment of skin diseases
with light has a long tradition – e.g. lupus vulgar-
is with the Finsen lamp in 1899, wound healing
and rickets with artificial UV light sources after

History of Lasers in Dermatology
3
1901, and psoriasis with the combination of light
and tar in 1925. Hence, it is no surprise that the
American Society for Laser Medicine and Surgery
honors a dermatologist, Leon Goldman, as the
father of lasers in medicine in the United States
[19]. Leon Goldman did his dermatological train-
ing in Zürich, London, and Cincinnati. He was
Chairman of the Department of Dermatology at
the University of Cincinnati when he learned of
the invention of Theodore Maimans ruby laser in
1960. He was convinced of the great potential of
lasers in medicine. In 1961, he founded the first
biomedical laser laboratory at the University of
Cincinnati [20]. In 1963, Goldman and his co-
workers published the first study on the effects of
lasers on skin describing the selective destruction
of pigmented structures of the skin including hair
follicles with the beam of the ruby laser. They not-
ed highly selective injury of pigmented structures
(black hair) with no evident change in the white
skin underneath [21, 22].
Goldman published on the possible treatment
of nevi, melanomas, and tattoos using the pulsed
ruby laser: ‘The most striking results have been
obtained with the removal of tattoos, especially
with the Q switched laser’. He expected the laser to
bring substantial benefits to the treatment of skin
cancer: ‘Because of the accessibility and color, la-
ser surgery can be used extensively in the field of
skin cancer. The most significant treatments have
been given for that black cancer of man, mela-
noma. Here, our laboratory has done laser op-
erations even in delicate areas such as melanoma
near the brain. It is too early to tell how perma-
nent the effects will be. . .’ [23] (fig. 1).
He preformed clinical and histopatholo gical
studies on vascular malformations with the ar-
gon laser. In 1973, Goldman published promising
effects on angiomas with the continu ous- wave
neodymium:yttrium- aluminium- garnet
(Nd:YAG) laser. His book Biomedical Aspects of the
Laser published in 1967 is a comprehensive over-
view over the possibilities, problems, and ideas of
the use of the laser in medicine at that time, also
emphasizing the need for protection from laser
energy. In addition, he discussed ideas of using
Fig. 1. Experimental treatment of
metastatic cutaneous melanoma
with a pulsed neodymium laser by
Leon Goldman [23].

4
Geiges
the laser as a diagnostic tool (transillumination)
to detect foreign bodies, hard tumors, or bone
defects, and presented data on the use of laser in
dentistry.
Photoexcision (the optical scalpel) was pos-
sible with continuous- wave lasers all invented in
1964; first the CO
2
laser, followed by the Nd:YAG-
laser and then the argon laser. For the CO
2
laser,
the color of the target area was not of any great sig-
nificance and with an out- of- focus beam and larg-
er spot size, hemostasis was also possible making
it a helpful tool for surgery on vasculated organs
(liver, oral mucosa, gynecology). Developments
in fiber optics made it possible to transmit far-
infrared laser beams, increasing the flexibility of
CO
2
lasers for endoscopic surgery. The argon la-
ser showed superior absorption by hemoglobin
and was used for treating port wine stains and
teleangiectasia of the face and early rhinophyma
[24].
The early continuous- wave lasers emitted an
uninterrupted beam of light that was effective in
destroying the desired target, but also exposed
the surrounding healthy tissue to laser energy
for prolonged periods. The result of this collat-
eral damage was unacceptably high rates of hy-
pertrophic scarring and pigment alteration. The
first attempt to minimize this nonspecific tissue
injury involved making the continuous- wave la-
sers discontinuous or quasi- continuous by us-
ing a mechanical shutter to interrupt the beam
of light. In the treatment of vascular lesions, the
development of the tunable yellow light dye laser
with the absorption peak closer to oxyhemoglo-
bin than the early argon lasers reduced the risk
of side effects. In 1996, the erbium (Er):YAG la-
ser with a very short wavelength of 2,940 nm al-
lowed a more superficial vaporization of tissue
and was used together with CO
2
lasers for skin
resurfacing. Very recently, the new technical
concept of fractional photothermolysis was in-
troduced. It received FDA approval in 2004 for
skin resurfacing and in 2005 for the treatment of
melasma [25].
Selective Photothermolysis
These developments support the common as-
sumption that progress in medicine (and laser
dermatology) depends mainly on new technol-
ogy; however, technical progress reflects only one
part of the history of the laser. Both acceptance of
and interest in observations depends very much
on the attitude of the involved persons. Even with-
in the short history of lasers in medicine, the ex-
ample of the pulsed laser systems shows how new
ideas foster new use of old technology [26].
Leon Goldman wrote in 1967: ‘There is ev-
ery indication that Q- switched lasers will remain
an important tool in the physicists’ laboratories
[23]. Despite the various treatment possibilities
that Goldman proposed and the encouraging re-
sults he published, there was an initial lack of in-
terest in the development and support of the use
of pulsed lasers by the government, industry, and
the armed forces. Surgeons focused their interest
on continuous rather than pulsed lasers [24]. The
ruby laser was ineffective when used as an optical
scalpel for cutting or coagulation, and when using
high- energy pulses the effect became unpredict-
able because of cavitations (vapor bubbles). The
attempts to use the pulsed Nd:YAG laser were not
more successful as tissue fragments were spattered
all over the operating room [26]. In the 1980s, the
pulsed ruby laser was commercialized in Japan for
the treatment of tattoos and pigmented lesions,
while being abandoned in Europe and the USA
where tattoo removal was performed by CO
2
laser
vaporization [27].
With the flashlamp- pumped pulsed dye laser
in the early 1980s, R. Rox Anderson and John A.
Parrish from the Department of Dermatology at
the Harvard Medical School in Boston developed
the theory of selective photothermolysis that rev-
olutionized the practice of cutaneous laser sur-
gery [28]. The authors recognized that the collat-
eral thermal damage in the surrounding tissue of
the target chromophore resulted from prolonged
exposure to the laser’s energy. By the appropriate

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References
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Abstract: Schawlow and Townes1 have proposed a technique for the generation of very monochromatic radiation in the infra-red optical region of the spectrum using an alkali vapour as the active medium. Javan2 and Sanders3 have discussed proposals involving electron-excited gaseous systems. In this laboratory an optical pumping technique has been successfully applied to a fluorescent solid resulting in the attainment of negative temperatures and stimulated optical emission at a wave-length of 6943 A. ; the active material used was ruby (chromium in corundum). After demonstration in 1954 of the 'maser' principle (microwave amplification by stimulated emission of radiation), systems were sought in which the effect occurred in the infrared and visible spectrum. This goal was reached in 1960 when Theodore Maiman achieved optical laser action in ruby.

3,646 citations


Journal ArticleDOI
T. H. Maiman1Institutions (1)
06 Aug 1960-Nature
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3,546 citations


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R. Rox Anderson1, John A. Parrish1Institutions (1)
29 Apr 1983-Science
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2,860 citations


Book
01 Jan 1958-
Abstract: The extension of maser techniques to the infrared and optical region is considered. It is shown that by using a resonant cavity of centimeter dimensions, having many resonant modes, maser oscillation at these wavelengths can be achieved by pumping with reasonable amounts of incoherent light. For wavelengths much shorter than those of the ultraviolet region, maser-type amplification appears to be quite impractical. Although use of a multimode cavity is suggested, a single mode may be selected by making only the end walls highly reflecting, and defining a suitably small angular aperture. Then extremely monochromatic and coherent light is produced. The design principles are illustrated by reference to a system using potassium vapor.

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