A system for treating a selected dermatological problem and a head for use with such system are provided. The head may include an optical waveguide having a first end to which EM radiation appropriate for treating the condition is applied. The waveguide also has a skin-contacting second end opposite the first end, a temperature sensor being located within a few millimeters, and preferably within 1 to 2 millimeters, of the second end of the waveguide. A temperature sensor may be similarly located in other skin contacting portions of the head. A mechanism is preferably also provided for removing heat from the waveguide and, for preferred embodiments, the second end of the head which is in contact with the skin has a reflection aperture which is substantially as great as the radiation back-scatter aperture from the patient's skin. Such aperture may be the aperture at the second end of the waveguide or a reflection plate or surface of appropriate size may surround the waveguide or other light path at its second end. The portion of the back-scattered radiation entering the waveguide is substantially internally reflected therein, with a reflector being provided, preferably at the first end of the waveguide, for returning back-scattered light to the patient's skin. The reflector may be angle dependent so as to more strongly reflect back scattered light more perpendicular to the skin surface than back scattered radiation more parallel to the skin surface. Controls are also provided responsive to the temperature sensing for determining temperature at a predetermined depth in the patient's skin, for example at the DE junction, and for utilizing this information to detect good thermal contact between the head and the patient's skin and to otherwise control treatment. The head may also have a mechanism for forming a reflecting chamber under the waveguide and drawing a fold of skin therein, and for providing a second enlarged waveguide to expand the optical aperture of radiation.