Patent Publication Number: US-2012041523-A1

Title: Skin treatment device utilizing light and temperature

Description:
TECHNICAL FIELD 
     The invention relates generally to the field of dermatological devices and in particular to a device exhibiting a combination of a temperature adjusting element and a light element arranged to irradiate the target skin. 
     BACKGROUND ART 
     Electromagnetic energy, and particularly light energy in the visible and near infra-red ranges are widely used in medical applications to treat skin disorders. A large range of medical skin conditions, and general aesthetic skin conditions are successfully treated with electromagnetic energy, including but not limited to acne, wrinkle eradication, skin tightening and skin rejuvenation. 
     U.S. Pat. No. 6,379,376 issued Apr. 30, 2002 to Lubart, the entire contents of which is incorporated herein by reference, is addressed to a method and device for promoting growth and proliferation of skin cells or tissue or for controlling bacterial skin infections. Unfortunately, the technique of Lubart is restricted to the use of light. 
     U.S. Patent Application S/N 2008/0300529 published Dec. 4, 2008 to Reinstein, is addressed to a method of treating the skin or body part, comprising contacting the skin or body part with a composition; and contacting the composition and heating and/or cooling the skin or body part with a thermoelectric Peltier device. Unfortunately there is no provision made for phototherapy. 
     Various products for skin treatment exist which provide a combination of heating and cooling for the skin. The combination is believed to provide various benefits including, but not limited to, skin rejuvenation, reduction of acne and associated inflammations, and improving circulation. 
     U.S. Pat. No. 7,473,251 issued Jan. 6, 2009 to Knowlton et al, the entire contents of which is incorporated herein by reference, is addressed to a method of creating a tissue effect at a tissue delivery site by delivering electromagnetic energy through a skin surface from an electromagnetic energy delivery device coupled to an electromagnetic energy source. 
     U.S. Pat. No. 7,351,252 issued Apr. 1, 2008 to Altshuler et al, the entire contents of which is incorporated herein by reference, is addressed to a method and apparatus for treating tissue in a region at depth by applying optical radiation thereto of a wavelength able to reach the depth of the region and of a selected relatively low power for a duration sufficient for the radiation to effect the desired treatment while concurrently cooling tissue above the selected region to protect such tissue. 
     Unfortunately, the prior art does not supply a low cost device providing a user with the combined benefits of both light and temperature therapies. 
     SUMMARY OF THE INVENTION 
     Accordingly, it is a principal object of the present embodiments to overcome at least some of the disadvantages of prior art devices for skin treatment. This is accomplished in certain embodiments by a hand held, home use, device exhibiting a combination of a light source and a temperature adjusting element, arranged such that irradiation from the light source passes through an aperture in the temperature adjusting element. 
     In one embodiment the temperature adjusting element is a thermoelectric element. In one embodiment the thermoelectric element is ring shaped, and light energy is provided through an aperture formed in the center opening of the ring shaped thermoelectric element, in another embodiment the thermoelectric element exhibits a matrix of pass-through perforations representing a plurality of apertures and light energy is provided through the plurality of apertures, and in another embodiment the thermoelectric element exhibits a plurality of parallel pass-through slits representing a plurality of apertures and light energy is provided through the plurality of apertures. Preferably, the plurality of apertures are spaced such that the pulsed light energy proceeding from adjacent apertures overlap within the skin treatment area at a predetermined epidermis depth 
     In one embodiment, the light source is a broad band light source providing light impacting the target area in the range of about 300-2000 nm, and in another embodiment the light source is filtered light providing light impacting the target area in the range of 590-2000 nm. 
     In one embodiment the light source is pulsed, the pulses being of a duration such that energy per pulse at the target skin area is 0.05-1 J/cm 2 , and preferably 0.3-0.6 J/cm 2 . The number of pulses is selected such to provide a fluence at the target skin area over a treatment session of 4-25 J/cm 2 , and preferably a fluence at the target skin area over a treatment session of 8-12 J/cm 2 . 
     In one embodiment the temperature adjusting element operates in a cooling mode and provides for a temperature of 0-25° C. in contact with the user skin, preferably 4-15° C. In one embodiment cold and light are alternately pulsed. 
     In one embodiment, the portion of the skin treatment area is in the range of 0.25-2 cm 2 . In another embodiment the portion of the skin treatment area is in the range of 0.5-1 cm 2 . 
     In one embodiment the pulse train of the light source exhibits a frequency of 0.1-10 Hz and a duty cycle of no more than 50%. In another embodiment the pulse train of the light source exhibits a frequency of 0.25-5 Hz and a duty cycle of no more than 50%. 
     In one particular embodiment, a hand held device for treatment of a skin treatment area is provided, the device comprising: a housing exhibiting an opening therein; a temperature adjusting element secured to an end of the housing, one end of the temperature adjusting element arranged to contact the skin treatment area, the temperature adjusting element exhibiting at least one aperture passing there through; a light source secured to the housing; a light path arranged to pass light energy from the light source to at least a portion of the skin treatment area via the at least one aperture; and a control and driving circuitry in electrical communication with each of the light source and the temperature adjusting element, the control and driving circuitry operative to: output a train of pulses to the light source thereby providing pulsed light energy to the portion of the skin treatment area from the light source proceeding through the aperture; and power the temperature adjusting element so as to adjust the temperature of the skin treatment area. 
     Independently certain embodiments provide for a method of treating skin is provided, the method comprising: applying a temperature adjusting surface to a skin treatment area; providing at least one aperture in the applied temperature adjusting surface; and providing pulsed light energy to a portion of the skin treatment area via the provided aperture. 
     In one further embodiment the temperature adjusting surface is a cooling surface exhibiting a temperature of less than 25° C. to the skin treatment area. In another further embodiment, the method further comprises: pulsing the temperature adjusting element alternately with the pulsed light energy. 
     In one further embodiment at least one aperture comprises a plurality of apertures spaced such that the pulsed light energy proceeding from adjacent apertures overlap within the skin treatment area at a predetermined epidermis depth. In another further embodiment the pulsed light energy provides a fluence of 4-25 J/cm 2  at the portion of the skin treatment area over a predetermined treatment time. 
     In one further embodiment pulsed light energy provides a fluence of 8-12 J/cm 2  at the portion of the skin treatment area over a predetermined treatment time. In another further embodiment the predetermined treatment time is in the range of 5-60 seconds. 
     In one further embodiment the predetermined treatment time is in the range of 25-35 seconds. In another further embodiment each of the pulses of the pulsed light energy provides a fluence of 0.05-1 J/cm 2  of light energy at the portion of the skin treatment area. 
     In one further embodiment each of the pulses of the pulsed light energy provides a fluence of 0.3-0.6 J/cm 2  of light energy at the portion of the skin treatment area. In another further embodiment the provided pulsed light energy exhibits wavelengths in the range of 300-2000 nm, preferably in the range of 590-2000 nm. 
     In one further embodiment the portion of the skin treatment area is in the range of 0.25-2 cm 2 , preferably in the range of 0.5-1 cm 2 . In another further embodiment the pulsed light energy exhibits a frequency of 0.1-10 Hz and a duty cycle of no more than 50%, preferably the pulsed light energy exhibits a frequency of 0.25-5 Hz and a duty cycle of no more than 50%. 
     Additional features and advantages will become apparent from the following drawings and description. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       For a better understanding of the invention and to show how the same may be carried into effect, reference will now be made, purely by way of example, to the accompanying drawings in which like numerals designate corresponding elements or sections throughout. 
       With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of the preferred embodiments of the present invention only, and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the invention. In this regard, no attempt is made to show structural details of the invention in more detail than is necessary for a fundamental understanding of the invention, the description taken with the drawings making apparent to those skilled in the art how the several forms of the invention may be embodied in practice. In the accompanying drawings: 
         FIG. 1A  illustrates a high level schematic diagram of a perspective view of a hand held device in accordance with certain embodiments; 
         FIG. 1B  illustrates a high level schematic diagram of a side cut view of the hand held device of  FIG. 1A ; 
         FIG. 1C  illustrates a high level schematic diagram of a skin treatment area for treatment with the hand held device of  FIGS. 1A ,  1 B; 
         FIG. 1D  illustrates a perspective view of an embodiment of a temperature adjusting element exhibiting a central single aperture in accordance with certain embodiments; 
         FIG. 1E  illustrates a perspective view of an embodiment of a temperature adjusting element exhibiting a matrix of substantially cylindrical apertures in accordance with certain embodiments; 
         FIG. 1F  illustrates a perspective view of an embodiment of a temperature adjusting element exhibiting a matrix of substantially box shaped apertures in accordance with certain embodiments; 
         FIG. 1G  illustrates a perspective view of an embodiment of a temperature adjusting element exhibiting a plurality of parallel slit shaped apertures in accordance with certain embodiments; 
         FIG. 1H  illustrates a side view of a skin treatment portion showing an overlap of radiation within the epidermis in accordance with certain embodiments; 
         FIG. 2  illustrates a high level block diagram of the hand held device of  FIGS. 1A and 1B  in accordance with certain embodiments; 
         FIG. 3  illustrates a high level schematic diagram in greater detail of the circuitry of hand held device of FIGS.  1 A, 1 B and  2  in accordance with certain embodiments; 
         FIG. 4  illustrates a graph of the power output of a light source during a treatment session in accordance with certain embodiments; 
         FIG. 5  illustrates a graph of the surface temperature of a user skin during a treatment session; and 
         FIG. 6  illustrates a high level flow chart of a method of skin treatment in accordance with certain embodiments. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of the components set forth in the following description or illustrated in the drawings. The invention is applicable to other embodiments or of being practiced or carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein is for the purpose of description and should not be regarded as limiting. 
       FIG. 1A  illustrates a high level schematic diagram of a perspective view of a hand held device  10 ,  FIG. 1B  illustrates a high level schematic diagram of a side cut view of hand held device  10 ,  FIG. 1C  illustrates a high level schematic diagram of a skin treatment area of hand held device  10  in accordance with certain embodiments, and  FIG. 1D  illustrates a perspective view of an embodiment of a temperature adjusting element in accordance with certain embodiments,  FIGS. 1A-1D  being taken together. Hand held device  10  comprises: a housing  20 ; a charger jack  25 ; a light path  30 ; a visual indicator  40 ; a user input device  50 ; a temperature adjusting element  60  exhibiting an aperture  65 ; a light source  70 ; an optional optical filter  80 ; a skin area  90  exhibiting a skin treatment area  100  and a skin treatment area portion  110 . 
     Visual indicator  40  preferably comprises one or more LEDs or an LCD display. User input device  50  is preferably a push button, and is illustrated as such, however this is not meant to be limiting in any way. In one embodiment light source  70  comprises an incandescent type bulb. In one embodiment, temperature adjusting element  60  is implemented as a thermoelectric device operative responsive to the Peltier effect, one temperature controlled side of which is arranged to contact skin area  90 . Temperature adjusting element  60  is arranged for placement in contact with skin area  90  and the portion of skin area  90  in communication with temperature adjusting element  60  defines skin treatment area  100 . The portion of skin area  90  irradiated by light proceeding from light source  70  via light path  30  and proceeding through aperture  65  defines skin treatment area portion  110 . In one non-limiting embodiment skin treatment area  100  is on the order of 3-6 cm 2 . In one embodiment skin treatment area portion  110  is in the range of 0.25-2 cm 2 , and preferably in the range of 0.5-1 cm 2 . 
     Temperature adjusting element  60  is illustrated as a ring shaped element, with light path  30  proceeding via central aperture  65  of ring shaped temperature adjusting element  60 , however this is not meant to be limiting in any way, and light path  30  and temperature adjusting element  60  may be provided as a matrix of apertures or a group of alternating parallel stripes, as described in relation to  FIGS. 1E-1G , or any other geometric combination. 
     Light source  70  outputs light energy, and in one embodiment the light energy output exhibits wavelengths in the range of 300-2000 nm. The light energy proceeding from light source  70  along light path  30  is optionally filtered by optional optical filter  80  to remove shorter wavelengths, and thus irradiate skin treatment area portion  110  with light energy exhibiting wavelengths in the range of 590-2000 nm. Longer wavelengths are optionally preferred as they provide deeper skin penetration. 
     Charger jack  25  provides for charging of an on-board rechargeable battery. Optionally, hand held device  10  is battery operated, or mains operated, without exceeding the scope. 
     In operation, and as will be described further hereinto below, responsive to a user input at user input device  50 , skin treatment area portion  110  is irradiated with light energy proceeding from light source  70 , preferably pulsed light energy, preferably with a frequency of 0.1-10 Hz and further preferably with a frequency of 0.25-5 Hz, for a total treatment time of 5-60 seconds, and preferably 25-35 seconds. The pulsed light energy exhibits a fluence over the total treatment time, defined at skin treatment area portion  110 , of 4-25 J/cm 2 , and preferably 8-12 J/cm 2 , with an energy per pulse of preferably 0.05-1 J/cm 2  and further preferably 0.3-0.6 J/cm 2 . In one embodiment, temperature adjusting element  60  is further powered to provide cooling of skin treatment area  100  over the total treatment time, and preferably the cooling is powered alternately with the pulsed light energy. In one embodiment the cooling temperature of temperature adjusting element  60  is 0-25° C., and preferably 4-15° C. In another embodiment, temperature adjusting element  60  is further powered to provide heating of skin treatment area  100  over the total treatment time, and preferably the heating is powered alternately with the pulsed light energy. 
       FIG. 1E  illustrates a perspective view of an embodiment of a temperature adjusting element  60  exhibiting a matrix of substantially cylindrical apertures  65  in accordance with certain embodiments. Optionally apertures  65  are sufficiently closely spaced so that the light energy from light source  70 , and particularly infra-red radiation, overlap at a predetermined depth of the epidermis of skin treatment area portion  110 , as illustrated in  FIG. 1H , wherein a skin treatment area depth  115  is shown wherein the radiation area expands with skin depth. Temperature element  60  of  FIG. 1E  is illustrated as a rectangular element, however this is not meant to be limiting in any way, and temperature element  60  may be implemented as a cylindrical shaped element or any other shape, without limitation, without exceeding the scope. 
       FIG. 1F  illustrates a perspective view of an embodiment of a temperature adjusting element  60  exhibiting a matrix of substantially box shaped apertures  65  in accordance with certain embodiments. Optionally apertures  65  are sufficiently closely spaced so that the light energy from light source  70 , and particularly infra-red radiation, overlap at a predetermined depth of the epidermis of skin treatment area portion  110 , as illustrated in  FIG. 1H , wherein a skin treatment area depth  115  is shown wherein the radiation area expands with skin depth. Temperature element  60  of  FIG. 1F  is illustrated as a rectangular element, however this is not meant to be limiting in any way, and temperature element  60  may be implemented as a cylindrical shaped element or any other shape, without limitation, without exceeding the scope. 
       FIG. 1G  illustrates a perspective view of an embodiment of a temperature adjusting element  60  exhibiting a plurality of parallel slit shaped apertures  65  in accordance with certain embodiments. Optionally, parallel slit shaped apertures  65  are sufficiently closely spaced so that the light energy from light source  70 , and particularly infra-red radiation, overlap at a predetermined depth of the epidermis of skin treatment area portion  110 , as illustrated in  FIG. 1H , wherein a skin treatment area depth  115  is shown wherein the radiation area expands with skin depth. Temperature element  60  of  FIG. 1G  is illustrated as a rectangular element, however this is not meant to be limiting in any way, and temperature element  60  may be implemented as a cylindrical shaped element or any other shape, without limitation, without exceeding the scope. 
     The alternating light and temperature therapy is believed to increase blood flow to skin treatment area  100 , and particularly skin treatment area portion  110 , thus increasing metabolism of the constituent cells of skin treatment area  100 . 
       FIG. 2  illustrates a high level block diagram of hand held device  10  of  FIGS. 1A and 1B  in accordance with certain embodiments comprising: housing  20  exhibiting a light path  30  arranged for placement in contact with skin treatment area portion  110 ; a light source  70 ; a control and driving circuitry  120 ; a reflector  140 ; an audible alarm  150 ; a visual indicator  40 ; a user input device  50 ; a temperature sensor  160 ; a rechargeable power source  170 ; a temperature adjusting element  60 ; an optional optical filter  80 ; and an optional air cavity  130 . Control and driving circuitry  120  is in communication with each of: visual indicator  40 ; user input device  50 ; temperature sensor  160 ; rechargeable power source  170 ; light source  70 ; and temperature adjusting element  60 . Light path  30  is defined by an optical channel between light source  70  and skin treatment area portion  110 , and in an exemplary embodiment, as described above, proceeds through one or more apertures  65  in temperature adjusting element  60 . Optional optical filter  80  is disposed within light path  30 , and is operative to filter out unwanted wavelengths output by light source  70 , preferably wavelengths of less than 590 nm. Optional air cavity  130  is formed between light source  70 , or between optional optical filter  80  if supplied, and skin treatment area portion  110 , and further supplies heat to skin treatment area portion  110 . In one embodiment the heat for optional air cavity  130  is supplied by light source  70 , and a temperature gradient is formed between light source  70  and skin treatment area portion  110 . In another embodiment a separate heating element (not shown) is further supplied. In yet another embodiment, in which temperature adjusting element  60  is implemented as a thermoelectric element, and the skin is cooled by temperature adjusting element  60 , the opposing heated side provides heat to optional air cavity  130 . In an embodiment in which optional optical filter  80  is supplied, and arranged to be in contact with skin treatment area portion  110 , optional air cavity  130  is not present. Temperature sensor  160  is arranged to sense a temperature associated with the temperature of one of skin treatment area  100  and skin treatment area portion  110 . 
     In operation, control and driving circuitry  120  senses a user input via user input device  50 . Responsive thereto, control and driving circuitry  120  is operative to energize visual indicator  40 , which preferably comprises one or more LEDs or an LCD display, thus indicating operation to the user. Visual indicator  40  may be further operative to output additional status indication, such as a charging status of rechargeable power source  170 , operation of light source  70 , and/or a temperature range of one of skin treatment area  100  and skin treatment area portion  110  responsive to the output of temperature sensor  160 . Audible alarm  150 , which in one embodiment is constituted of a buzzer, is operative to audibly notify a user of the end of the treatment session, or alternatively of a failure condition of any of light source  70  and temperature adjusting element  60 , or an out of temperature range condition. Control and driving circuitry  120  is further preferably operative to adjust one or more of the PWM duty cycle of temperature adjusting element  60 , the PWM duty cycle of light source  70 , the power per cycle applied to temperature adjusting element  60  and the power per cycle applied to light source  70  responsive to temperature sensor  160 , thus ensuring that the temperature of one of skin treatment area  100  and skin treatment area portion  110  remains within predetermined parameters. In one non-limiting embodiment, a plurality of different treatment programs are user selectable via user input device  50 , such as a low energy program, a moderate energy program and a maximum energy program, each of which programs provide energy in a different powering range. 
     Light source  70  is secured in relation to housing  20 , and preferably secured within housing  20 , and receives pulsed power from control and driving circuitry  120  exhibiting an on time during which a current is driven through light source  70  and an off time during which current is not driven through light source  70 . Preferably, the pulsed power exhibits a duty cycle of up to 50%. Reflector  140  is disposed within housing  20  and is arranged to reflect light exiting light source  70  towards light path  30 . In one non-limiting embodiment, light source  70  is constituted of an incandescent or halogen type bulb. 
     As described above, temperature adjusting element  60  is in one non-limiting embodiment a thermo-electric element working responsive to the principle of the Peltier effect. In another non-limiting embodiment temperature adjusting element  60  comprises at least one of a gas, liquid and solid, or a plurality thereof, normally used for cooling. As described above in relation to  FIGS. 1A and 1B , temperature adjusting element  60  is preferably arranged to be in contact with skin treatment area  100 , and exhibits an aperture  65  for the passage of light energy from light source  70 . The area of impact of light energy defines skin treatment area portion  110 . Temperature adjusting element  60  is responsive to control and driving circuitry  120  and receives pulsed power there from exhibiting an on time in which temperature adjusting element  60  is operative to cool skin treatment area  100  and an off time when temperature adjusting element  60  does not provide cooling, except for any residual cooling caused by the thermal mass of temperature adjusting element  60 . Preferably, temperature adjusting element  60  is pulsed with power alternately with the pulsed energy supplied to light source  70 . Thus, when light source  70  outputs light energy, temperature adjusting element  60  is quiescent, and when light source  70  is quiescent, temperature adjusting element  60  is active to cool skin treatment area  100 . In one embodiment the cooling temperature of temperature adjusting element  60  is 0-25° C., and preferably 4-15° C. 
     Control and driving circuitry  120  is connected to rechargeable power source  170 , and is operative to monitor the status thereof, control charging thereof and draw power there from. 
     As indicated above, in another embodiment, temperature adjusting element  60  is responsive to control and driving circuitry  120  and receives pulsed power there from exhibiting an on time in which temperature adjusting element  60  is operative to heat skin treatment area  100  and an off time when temperature adjusting element  60  does not provide heating, except for any residual heating caused by the thermal mass of temperature adjusting element  60 . 
       FIG. 3  illustrates a high level schematic diagram of the circuitry of hand held device  10  of  FIGS. 1A ,  1 B and  2  in accordance with certain embodiments, showing in greater detail control and driving circuitry  120 . Hand held device  10  comprises: a light source  70 ; a control and driving circuitry  120 ; an audible alarm  150 ; a visual indicator  40 ; a user input device  50 ; a temperature sensor  160 ; a rechargeable power source  170 ; and a temperature adjusting element  60 . Control and driving circuitry  120  comprises: a control block  200 ; a pulse width modulation (PWM) generator  210 ; a light source driving circuitry  220 ; a temperature adjusting element driving circuitry  230 ; and a timer  180 . 
     Control block  200  is in communication with PWM generator  210 , light source driving circuitry  220 , temperature adjusting element driving circuitry  230 , timer  180 , user input device  50 , visual indicator  40 , audible alarm  150 , rechargeable power source  170  and temperature sensor  160 . A first output of PWM generator  210  is fed to light source driving circuitry  220 , and the output of light source driving circuitry  220  is connected to light source  70 . A second output of PWM generator  210  is fed to temperature adjusting element driving circuitry  230 , and the output of temperature adjusting element driving circuitry  230  is connected to temperature adjusting element  60 . 
     In operation, control block  200  monitors the status of rechargeable power source  170 . In the event that rechargeable power source  170  is connected to an external charging source via charger jack  25 , as described above in relation to  FIG. 1A , and the voltage of rechargeable power source  170  exceeds a predetermined maximum, charging of rechargeable power source  170  is interrupted. 
     As described above, responsive to a user action at user input device  50 , control block  200  is activated to begin a treatment session. In one embodiment a treatment session is within the range of 5-60 seconds, preferably in the range of 25-35 seconds. Preferably, control block  200  is operative to set timer  180  to load the value of the predetermined treatment session and to output a signal at the end of the predetermined treatment session. Visual indicator  40  is set to indicate operation. In a preferred embodiment PWM generator  210  is set to produce a pulse train exhibiting a 50% duty cycle. Further preferably, the output of PWM generator  210  connected to light source driving circuitry  220  operates alternately with the output of PWM generator  210  connected to temperature adjusting element driving circuitry  230 . Once PWM generator  210  has stabilized, light source driving circuitry  220  and temperature adjusting element driving circuitry  230  are enabled, and timer  180  is initialized. In one embodiment the frequency of PWM generator  210  is set to be 0.1-10 Hz, and preferably 0.25-5 Hz. In one embodiment the frequency of PWM generator  210  can be adjusted during treatment by control block  200 . In another embodiment PWM generator  210  is set to produce a pulse train exhibiting a duty cycle up to 50%. In another embodiment the duty cycle of the pulse train can be adjusted during treatment by control block  200 . In one particular embodiment, as described above, the duty cycle is adjusted responsive to an output of temperature sensor  160 . In another embodiment PWM generator  210  is operative to produce two independent pulse trains, with light source driving circuitry  220  arranged to drive light source  70  responsive to a first of the two pulse trains and temperature adjusting element driving circuitry  230  arranged to drive temperature adjusting element  60  responsive to a second of the two pulse trains. 
     The operation of light source driving circuitry  220  and temperature adjusting element driving circuitry  230  is continued until a signal is received from timer  180  indicating that the treatment session has completed. Upon completion of the predetermined treatment session time, light source driving circuitry  220  and temperature adjusting element driving circuitry  230  are each disabled, and preferably an audible indicator is output via audible alarm  150 . The overall fluence of the light received at skin treatment area portion  110  over the treatment session is in one embodiment 4-25 J/cm 2 , and preferably 8-12 J/cm 2 , and the power and duty cycle of light element driving circuitry  220  is set to achieve the desired fluence. Preferably, the fluence of each light pulse is 0.05-1 J/cm 2 , and further preferably 0.3-0.6 J/cm 2 . In the event that an out of temperature range is detected by control block  200  responsive to temperature sensor  160 , the duty cycle of one or more of light source driving circuitry  220  and temperature adjusting element driving circuitry  230  is preferably adjusted to maintain skin temperature within acceptable parameters. 
       FIG. 4  illustrates a graph of the power output of light source  70  during a treatment session, in which the x-axis represents time in seconds and the y-axis represents power output in Watts measured at skin treatment area portion  110  of  FIG. 1C . In one embodiment, the initial pulses are of greater intensity and width so as to achieve greater absorption by the target area skin portion, since the skin absorbs energy more efficiently at the beginning of the treatment due to the initial low temperature of the skin. During treatment, as described above, PWM generator  210  produces a pulse train, optionally with an adjustable duty rate, thereby enabling light source driving circuitry  220  to drive light source  70 . In a preferred embodiment, as described above, light source  70  and temperature adjusting element  60  are driven alternately, with temperature adjusting element  60  being driven by temperature adjusting element driving circuitry  230  when light source driving circuitry  220  is not driving light source  70 . 
       FIG. 5  illustrates a graph of the surface temperature of skin treatment area portion  110  of  FIG. 1C  during treatment, where temperature adjusting element  60  is operated in a cooling mode, in which the x-axis represents time in seconds and the y-axis represents surface skin temperature in degrees centigrade. As described above in relation to  FIG. 4 , at the beginning of a treatment light source  70  is in one embodiment driven with long pulses. This results in relatively large rises in the surface temperature of skin treatment area portion  110  as it is irradiated for relatively long periods, and because the skin absorbs energy more efficiently at the beginning of the treatment due to the initial low temperature of the skin, as described above. After the initial long pulses, light source  70  is driven with shorter pulses, thereby resulting in smaller rises of the surface temperature of skin treatment area portion  110 . As described above temperature adjusting element  60  is driven, preferably during the periods when light source  70  is not driven, thereby cooling the surface temperature of skin treatment area  100 , and in particular skin treatment area portion  110 . The alternating pulses of cooling power and irradiation results in a more effective treatment, particularly believed to increase blood flow and as a result cell metabolism. As shown, after each rise in the surface temperature of skin treatment area portion  110 , temperature adjusting element  60  causes a decrease in the surface temperature of skin treatment area portion  110  thereby tightening skin treatment area portion  110  and resulting in more effective treatment. 
       FIG. 6  illustrates a high level flow chart of a method of skin treatment in accordance with certain embodiments where the temperature adjusting element is used in a cooling mode. In stage  1000 , a temperature adjusting surface such as temperature adjusting element  60  described above, is applied to a skin treatment area, such as skin treatment area  100  described above, the temperature adjusting surface being provided with one or more apertures. In stage  1010 , a pulsed light energy is applied to a portion of the skin treatment area of stage  1000  via a light path proceeding through the one or more apertures of stage  1000 . Optionally, the light energy is pulsed at a frequency of 0.1-10 Hz, and preferably 0.25-5 Hz, with a duty cycle of up to 50%. In optional stage  1020  the temperature adjusting element is powered in the cooling mode, providing cooling to the skin treatment area, by a pulsed power, exhibiting a temperature of less than 25° C., preferably alternately with the pulsed power of stage  1010 . There is no requirement that stage  1010  precedes stage  1020 , and stage  1020  may precede stage  1010  without exceeding the scope. 
     In optional stage  1030 , the one or more apertures of stage  1000  are provided as a one of a central aperture, a matrix of apertures and a plurality of parallel slit shaped apertures. 
     In optional stage  1040 , the pulsed light energy of stage  1010  is arranged to provide a fluence in the range of 4-25 J/cm 2 , and preferably 8-12 J/cm 2 , over a treatment session time predetermined to be preferably in the range of 5-60 seconds, and further preferably in the range of 25-35 seconds. Optionally, the energy per pulse is set to 0.05-1 J/cm 2  and preferably 0.3-0.6 J/cm 2 . 
     In optional stage  1050 , the pulsed light energy of stage  1010  is arranged to be a broadband light source exhibiting wavelengths in the range of 300-2000 nm, and further optionally the light is filtered to exhibit wavelengths in the range of 590 of 2000 nm. 
     In optional stage  1060 , the skin treatment area portion of stage  1010  is set to be in the range of 0.25-2 cm 2 , and preferably 0.5-1 cm 2 . 
     In stage  1070  the treatment period time is monitored. In one non-limiting embodiment, the treatment period time is monitored by checking an input from timer  180  of  FIG. 3 . In the event that the treatment period has ended, in stage  1080 , treatment is stopped, preferably by disabling stages  1010 ,  1020 . In one embodiment an audible and/or visual warning is further supplied to the user. In the event that in stage  1070  the treatment period has not ended, stage  1010  as described above is again performed. 
     Thus, certain of the present embodiments enable a hand held, home use, device exhibiting a combination of a light source and a temperature adjusting element exhibiting an aperture. In one embodiment the temperature adjusting element is a thermoelectric element provided with one of a central aperture, a matrix of apertures or a plurality of parallel slit shaped apertures, and light energy is provided through the aperture to the skin. In one embodiment, the light source is a broad band light source providing light impacting the target area in the range of about 300-2000 nm, and in another embodiment the light source is filtered light providing light impacting the target area in the range of 590-2000 nm. 
     In one embodiment the light source is pulsed, the pulses being of a duration such that energy per pulse at the target skin area is 0.05-1 J/cm 2 , and preferably 0.3-0.6 J/cm 2 . The number of pulses is selected such to provide a fluence at the target skin area over a treatment session of 4-25 J/cm 2 , and preferably a fluence at the target skin area over a treatment session of 8-12 J/cm 2 . 
     In one embodiment the temperature adjusting element in a cooling mode provides for a temperature of 0-25° C. in contact with the user skin, preferably 4-15° C. In one embodiment cold and light are alternately pulsed. 
     It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable sub-combination. In the claims of this application and in the description of the invention, except where the context requires otherwise due to express language or necessary implication, the word “comprise” or variations such as “comprises” or “comprising” is used in any inclusive sense, i.e. to specify the presence of the stated features but not to preclude the presence or addition of further features in various embodiments of the invention. 
     Unless otherwise defined, all technical and scientific terms used herein have the same meanings as are commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods similar or equivalent to those described herein can be used in the practice or testing of the present invention, suitable methods are described herein. 
     All publications, patent applications, patents, and other references mentioned herein are incorporated by reference in their entirety. In case of conflict, the patent specification, including definitions, will prevail. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting. No admission is made that any reference constitutes prior art. The discussion of the reference states what their author&#39;s assert, and the applicants reserve the right to challenge the accuracy and pertinency of the cited documents. It will be clearly understood that, although a number of prior art references are referred to herein, this reference does not constitute an admission that any of these documents forms part of the common general knowledge in the art in any country. 
     It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather the scope of the present invention is defined by the appended claims and includes both combinations and sub-combinations of the various features described hereinabove as well as variations and modifications thereof, which would occur to persons skilled in the art upon reading the foregoing description.