Intense Pulsed Light Treatment of Photoaged Facial Skin

BACKGROUND: It has been reported that intense pulsed light is efficacious for rejuvenation of photoaged skin, specifically the improvement of appearance of telangiectases and solar lentigines. OBJECTIVE: The objective was to define the treatment variables for photodamaged facial skin using a newer intense pulsed light system. METHODS: Twenty-three female subjects received three treatments using double-stacked pulses with fluences of 24 and 30 J/cm2. Response to treatment was evaluated using digital photography. Three signs of photoaging were evaluated: surface texture/roughness, mottled hyperpigmentation, and erythema/telangiectases. RESULTS: There was a shift in clinical grading from more to less severe on all three measures of photoaging. CONCLUSION: Intense pulsed light therapy was efficacious in ameliorating the clinical signs of photoaging. The device was well tolerated with minimal side effects.     

Intense Pulsed Light Treatment of 1,000 Consecutive Patients with Facial Vascular Marks

Background: Facial teleangectasias or vascular marks often represent a very cosmetically detracting problem for the affected patient, who tries to cover the lesions by camouflage strategies. This study describes the response of these vascular lesions after an intense pulsed light source was used on 1,000 consecutive patients. Methods: Between October 1998 and April 2005, 1,000 consecutive patients with various skin types (Fitzpatrick I to IV) were treated with Photoderm VL. The average age of the patients was 47.1 years. These patients were subjected to a mean of 2.16 treatments (range, 1–9), then followed up 48 h, 72 h, 1 week, 3 weeks, and 1 month after each treatment. All the patients were followed up 2 months after the last treatment, and the percentage of clearance was assessed by comparison of pre- and posttreatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The final physicians-nurse evaluation also was recorded on the same form. Results: Most of the patients (89.70%) experienced a clearance of 75% to 100%. The results appear to be correlated with operator experience, but not with lesion size, age, or skin type. Minimal adverse side effects occurred for 14.6% of the patients, but only for 6.76% of the treatments. Conclusion: The intense pulsed light source Photoderm VL can be considered a fast, safe, and effective treatment for facial teleangectasias or vascular marks.     

Intense Pulsed Light for the Treatment of Facial Freckles in Asian Skin

BACKGROUND: Freckles are melanotic lesions frequently seen on the face and other sun-exposed areas. Previously evaluation of the severity of freckles has relied on the ultimately subjective assessment of the doctor or patient. Intense pulsed light (IPL) is newly introduced to treat facial freckles in Asian skin. OBJECTIVE: To determine the effectiveness of IPL treatment for Asian patients with freckled skin and to assess a new and objective method for evaluation of the severity of freckling and posttherapy improvement using an ultraviolet (UV)-sensitive camera and film. METHODS: Thirty-six patients with freckles were enlisted. IPL treatment was administered to patients with freckles in 4-week sessions. Irradiation wavelength was controlled using cutoff filters ranging from 550 to 590 nm, with a fluence of 25-35 J/cm2, with single- or double-pulse illumination and a pulse width of 4.0 msec. The assessments of the physician and patient were compared with the objective dermatologic evaluation with black-and-white and UV photography used to derive two treatment parameters, cosmetic density of freckles (CDF) and freckles area and severity index (FASI), which are applicable in a clinical setting. RESULTS: By the end of the study, two attending physicians assessed the results for 86.1% of the subjects as excellent or good, with 91.7% of the patients reporting that they were extremely or very satisfied. A statistically significant improvement in mean FASI score was demonstrated at 6 months after treatment compared with baseline (n = 36, p <.005; paired t-test). Mean overall improvement rate (n = 36), as determined from the difference in mean FASI score, was 63% at 12 weeks and 58% at 6 months. CONCLUSION: IPL is an effective and safe treatment for facial freckles in Asian skin, with relatively few adverse effects and high satisfaction levels.     

Split-Face Treatment of Facial Dyschromia: Pulsed Dye Laser with a Compression Handpiece versus Intense Pulsed Light

BACKGROUND Many visible light lasers and intense pulsed light (IPL) devices are available to treat photodamaged skin.
OBJECTIVES The objective was to perform a multiple-treatment split-face comparison evaluating a pulsed dye laser (PDL) with a compression handpiece versus IPL for photorejuvenation.
METHODS Ten subjects were treated three times at 3- to 4-week intervals. One side of the face was treated with the PDL with compression handpiece, and the other with IPL. One month after final treatment, blinded evaluation assessed for improvements in dyschromias and texture. Patients provided self-assessment of improvement in dyschromias and texture. Time to complete final treatments and pain during all treatments were recorded for each device.
RESULTS Improvement of the PDL was (mean) 86.5, 65, 85, 38, and 40% for dark lentigines, light lentigines, vessels <0.6 mm, vessels >0.6 mm, and texture, respectively, versus 82, 62.5, 78.5, 32.5, and 32%, respectively, for the IPL side. Patient-evaluated difference in improvement for vascular lesions significantly favored the PDL ( p =.011). Mean third treatment times were 7.7 minutes for PDL versus 4.6 minutes for the IPL ( p =.005). Mean pain ratings were 5.8 for the PDL and 3.1 for the IPL ( p =.007). Purpura-free procedures depended on proper technical use of the compression handpiece when treating lentigines with the PDL.
CONCLUSIONS The PDL with compression handpiece and IPL are highly effective for photorejuvenation.     

Vesiculobullous Eruption from Intense Pulsed Light Treatment

BACKGROUND: Intense pulsed light (IPL) systems emit non-coherent, polychromatic light and are increasingly used for various dermatologic indications. Although generally regarded as safe therapy, IPL is not without risk. OBJECTIVE: We report a 21-year-old woman who experienced a severe blistering eruption after IPL treatment by a nonphysician. MATERIALS AND METHODS: Case report. RESULTS: The patient reported a 10-year history of persistent redness on her medial and lateral cheeks. She had tried no previous oral or topical therapies. She was diagnosed with rosacea and was treated with IPL. The following day, intense vesiculation and bullae formation occurred, progressing to dramatic facial edema by day 3 and eschar formation by day 5. Ten weeks later, prominent erythema with papularity remained on both cheeks and the lateral neck, with textural change and reticulated dyschromia. She continued to recover 20 weeks after treatment. CONCLUSION: This case most likely represents high-fluence photothermal tissue injury induced by the laser-like qualities of the IPL source, with resulting acantholysis leading to formation of vesicobullae in the context of an uncertain primary diagnosis. This case highlights the potential hazards of IPL therapy and raises questions regarding appropriate use of this medical technology.     

Treatment of Facial Lentigines in Peutz–Jeghers Syndrome With an Intense Pulsed Light Source

BACKGROUND: Peutz-Jeghers syndrome is a hereditary condition characterized by distinctive mucocutaneous lentigines and intestinal hamartomatous polyposis. The cutaneous lesions may be cosmetically disfiguring and frequently present a therapeutic challenge. OBJECTIVE: To determine if intense pulsed light (IPL) is effective in treating facial lentigines in Peutz-Jeghers syndrome. METHODS: The IPL, utilizing a 590 nm cutoff filter, was used to treat facial lentigines in a 10-year-old girl with Peutz-Jeghers syndrome. RESULTS: A series of 12 treatment sessions, each to different facial regions, resulted in complete clearance of lentigines in the treated areas. Most of the lentigines resolved after a single treatment, with a few areas requiring a second treatment. CONCLUSION: In this case, treatment with IPL resulted in dramatic improvement of cosmetically disfiguring lentigines. To our knowledge, this is the first report of using IPL in Peutz-Jeghers syndrome.     

Skin Allograft in the Treatment of Toxic Epidermal Necrolysis (TEN)

BACKGROUND: TEN is a severe form of exfoliative dermatitis. Its course is acute and its outcome fatal in 40% of cases. Wound cover to prevent fluid/protein loss and infections and to control pain, is the first step, as for burns. Skin allograft can be successfully used for this purpose. OBJECTIVE: We report two cases of TEN with de-epithelialization of 50 and 70% of the total body surface area. The patients were given support therapy and treated with human glycerol-preserved skin allografts for wound cover. METHODS: Patients were grafted with glycerol-preserved donor skin, obtained from a skin bank. RESULTS: Re-epithelization of treated areas was complete in 8 days; pain relief was obtained soon after the graft. CONCLUSIONS: Glycerol-preserved skin allograft is an effective treatment in extensive skin loss, for its barrier and analgesic effect. Quality standards of this product ensure safety and simplicity of use at limited cost.     

强脉冲光治疗面部痤疮后红斑及炎性色素沉着236例疗效观察

目的:观察强脉冲光(I PL)治疗面部痤疮后红斑及炎性色素沉着的临床疗效。方法:采用皇后光子嫩肤仪对有面部痤疮红斑及炎性色素沉着的患者进行治疗,波长560～1200nm,能量密度16～28J/cm2,治疗3～5次为1个疗程,每次治疗间隔时间为4周,1个疗程后观察疗效。结果:236例患者中褐黑色炎性色素沉着51例,红斑137例,红斑加色素沉着48例,其中111例痊愈,显效101例,有效24例,总有效率达100%。结论:I PL治疗痤疮后红斑及炎性色素沉着无创、有效,可临床推广应用。     

Leukotrichia Developed Following Application of Intense Pulsed Light for Hair Removal

BACKGROUND: Lasers and light sources are now used worldwide for permanent or prolonged hair removal. Patients now prefer lasers and light sources for hair removal because of their noninvasiveness and fewer reported side effects. OBJECTIVE: To study and report on leukotrichia that developed following application of intense pulsed light (IPL). METHODS: From February 9, 2001 to February 14, 2002 a total of 821 patients were treated for unwanted hair. The system used was a noncoherent IPL system, with a 650 nm flashlamp filter; the parameters used varied with different Fitzpatrick skin types. The patients were treated monthly, with the rate of hair loss, measured by hair counts, and possible side effects recorded. RESULTS: Twenty-nine of 821 patients treated developed leukotrichia. Thirteen patients had no white or gray hairs before IPL therapy; the remaining 16 patients, who had few white hairs before treatment reported accelerated development of new white hairs starting after the first or second IPL therapy. Restoration of hair color occurred in 9 patients and the remaining 20 patients had no improvement or worsening of the condition within the next 2-6 months. CONCLUSION: Temporary or permanent leukotrichia may develop following IPL and laser hair removal therapy. This finding may be explained by the difference in the thermal relaxation times of melanocytes and germinative cells. The light absorbed and the heat produced by melanin may be sufficient enough to destroy or impair the function of melanocytes but insufficient to damage the hair follicle cells.     

Effective Treatment of Rosacea Using Intense Pulsed Light Systems

BACKGROUND: To date, a variety of lasers have been used for treating vascular skin lesions. Intense pulsed light (IPL) is a proven technology for vascular lesion management, such as rosacea. OBJECTIVES: The aim of this study was to test the effectiveness of IPL in treating vascular facial lesions in rosacea patients. METHODS: Sixty patients presenting with telangiectasia owing to facial rosacea were selected randomly from the patient population in the Department of Laser Therapy at the Medical Centre Maastricht, the Netherlands. Patients of various skin types (Fitzpatrick I-IV) were selected with an average age of 44.2 years. Five hundred eight sites were treated, with a mean of 4.1 treatments per site and an IPL spectrum ranging from 515 to 1,200 nm with different pulse durations between 4.3 and 6.5 milliseconds. The energy density varied from 25 to 35 J/cm2. RESULTS: Patients were assessed clinically and photographically. A mean clearance of 77.8% was achieved and was maintained for a follow-up period averaging 51.6 months (range 12-99 months). No correlation was found between the clearance of rosacea and patient-related or technical data. For approximately 3 years post-treatment, lesion recurrence was noted in 4 of the 508 treated facial sites. DISCUSSION: This study demonstrated that IPL treatment of facial rosacea is effective in obtaining clearance of 77.8%, with minimal side effects, and that treatment effects are maintained. CONCLUSION: The IPL system, with its broad range of technical variables, is an effective tool in achieving meaningful and lasting rosacea clearance.     

Intense Pulsed Light in the Treatment of Striae Distensae

BACKGROUND: Intense Pulsed Light (IPL) is a noncoherent, nonlaser, filtered flashlamp, emitting a broadband visible light. Its efficacy has been reported recently in the treatment of photodamaged facial skin, promoting the production of neo collagen and ordering of elastic fibers. We don't know however, its efficacy in the treatment of striae distensae. OBJECTIVE: To assess gross and microscopical changes that occur in the striae distensae when treated by IPL. METHODS: A prospective study was carried out in 15 women, all of them having late stage striae distensae of the abdomen. Five sessions of IPL were performed in each one, once every two weeks. Skin biopsies and before and after photographs were taken of all the patients. Data concerning skin features (number of stretch marks in a square of 5 cm per side, sum of all the stretch marks to determine the total length, discolorations and general appearance) were all assessed before each session and at the end of the study. Microscopical changes were all carefully assessed. For the statistical analysis a "t" test for small samples was used. RESULTS: All patients showed clinical and microscopical improvement in each one of the parameters assessed. The "t" test for small samples showed a statistically significative difference (p < 0.01) in the post treatment dermal thickness. CONCLUSION: Striae distensae improved clinically and microscopically after IPL. It seems to be a promising method of treatment for this common problem with minimal side-effects, a wide safety margin and no downtime.     

Intense Pulsed Light and Laser Treatment of Facial Telangiectasias and Dyspigmentation: Some Theoretical and Practical Comparisons

Background and Objective. A comparative overview is presented, both theoretical and clinical, for intense pulsed light (IPL) and laser treatment of facial telangiectasias and pigmented lesions.
Materials and Methods. A narrative approach describes light penetration into the epidermis, dermis, dermal-epidermal junction, and facial ectasias. Based on mathematical models, we examine some temperature profiles for monochromatic and broadband light sources. Specifically, temperature elevations of representative vascular targets are discussed. Also, clinical scenarios are reviewed for both IPL and laser. Although multiple monochromatic devices are reviewed, only the 532 and 595 nm wavelengths are emphasized.
Results. In theory, an IPL can be filtered to simulate 532 and 595 nm laser light in the treatment of telangiectasias and dyschromias. In comparing our experiences with the different devices, all three (IPL, 532 nm laser, and 595 nm laser) are capable of achieving a reduction in ectasias and hyperpigmented macules.
Conclusions. With an optimal set of parameters, IPLs and lasers are comparable in the treatment of vascular and pigmented lesions with respect to treatment efficiency and safety.     

窄谱强脉冲光联合重组人表皮生长因子凝胶治疗面部痤疮瘢痕疗效分析

目的:探讨窄谱强脉冲光联合重组人表皮生长因子凝胶治疗面部痤疮瘢痕的临床疗效。方法:选取2017年2月-2018年3月笔者医院收治的80例面部痤疮瘢痕患者,随机分为对照组与观察组,每组40例。对照组给予窄谱强脉冲光照射治疗,观察组在对照组基础上给予重组人表皮生长因子凝胶涂抹。对比两组临床疗效,比较结痂持续时间、痂皮脱落时间及治疗后痤疮瘢痕权重评分(clinical evaluation scale for acnescarring,ECCA),观察不良反应发生情况及治疗前后的痤疮特异性生活质量量表(Acne-specific Quality of Life Questionnaire,Acne-QOL)评分,并统计随访3个月患者复发率。结果:两组临床疗效等级分布比较差异具有统计学意义(P<0.05),观察组总有效率高于对照组,差异具有统计学意义(P<0.05);观察组结痂持续时间与痂皮脱落时间均短于对照组,观察组治疗后ECCA评分小于对照组,差异均具有统计学意义(P<0.05);观察组治疗后总不良反应发生率低于对照组,差异具有统计学意义(P<0.05);两组治疗后Acne-QOL量表中社会功能、自我认知、情感功能及痤疮症状评分均高于治疗前,观察组治疗后Acne-QOL量表各维度评分均高于对照组,差异均具有统计学意义(P<0.05);随访3个月,两组复发率差异无统计学意义(P>0.05)。结论:窄谱强脉冲光联合重组人表皮生长因子凝胶虽未能有效预防痤疮瘢痕复发,但可明显改善面部痤疮瘢痕患者临床症状,提高疗效,缩短结痂与痂皮脱落时间,并可减轻不良反应及提高患者生活质量。     

CO2 点阵激光和强脉冲光治疗面部光老化的疗效比较

目的 对CO2点阵激光和强脉冲光治疗面部光老化的效果进行比较。方法 选取我院2017年 1月-2018年1月收治的面部光老化患者100例,随机分为对照组及观察组,各50例。对照组行强脉冲光治疗, 观察组行CO2点阵激光治疗,比较两组治疗效果、不良反应发生率及复发率。结果 观察组治疗总有效率为 96.00%,高于对照组的84.00%（P＜0.05）;观察组不良反应发生率为6.00%,低于对照组的20.00%（P＜0.05）; 观察组复发率为6.00%,低于对照组的22.00%（P＜0.05）。结论 与强脉冲光相比,采用点阵激光技术治疗面 部皮肤光老化,能够有效改善患者的满意程度,治疗后要注意使用抗生素避免皮肤感染,通过多种措施预防 不良反应,为治疗效果提供保证。     

Treatment of Poikiloderma of Civatte with an Intense Pulsed Light Source

BACKGROUND: Effective treatment of poikiloderma of Civatte combines elimination of both the vascular and pigmented components simultaneously. A broad spectrum, noncoherent, intense pulsed light (IPL) source delivers multiple wavelengths with software controlled pulse durations and sequencing, which permits treatment of both vascular and pigmented lesions simultaneously. OBJECTIVE: To determine response and side effects of poikiloderma of Civatte of the neck and chest when treated by IPL. METHODS: One hundred and thirty-five patients randomly selected with typical changes of poikiloderma of Civatte on the neck and/or upper chest were treated with one to five treatments using IPL. RESULTS: Clearance of more than 75% of telangiectasias and hyperpigmentation comprising poikiloderma was observed. The incidence of side effects was 5%, including pigment changes. In many cases, improved skin texture was noted both by physician and patient. CONCLUSION: IPL is an effective mode of therapy for poikiloderma of Civatte. It offers a reduction of pigment and telangiectasias with a low risk profile. Additional benefits include subjective changes of improvement in skin texture.     

Melasma Treated with Intense Pulsed Light

Background  

Hypermelanosis includes a diverse group of genetic and acquired skin anomalies that appear as darker, hyperpigmented areas. Melasma, in particular, is a hypermelanotic condition that affects sun-exposed skin in females. Whether this condition is acquired or genetic is still controversial. However, it clearly correlates with exposure to UV light, a genetic predisposition, and hormonal variations (from pregnancy or oral contraceptives).     

Intense Pulsed Light for Melanocytic Lesions

BACKGROUND: Few reports about melanocytic lesion treatment using intense pulsed light have been published. OBJECTIVES: To evaluate the clinical results of diverse melanocytic lesions after treatment with an intense pulsed light source. METHODS: Superficial and deep melanocytic lesions were treated by an intense pulsed light source with the following parameters: filters of 590, 615, and 755 nm, a fluence energy of 34-38 J/cm2, double mode, a pulse width of 3.8-4.5 msec, and a delay of 20 msec, at 4- to 8-week intervals. Two treatment sessions were applied to superficial lesions, while deep ones received four. RESULTS: A clearance of 76-100% (excellent) was obtained for superficial lesions such as ephelides, epidermal melasma, and café au lait macules. Nevus spilus showed good clinical clearance (51-75%); however, deep lesions such as nevus of Becker, epidermal nevus, and mixed melasma showed an average clearance of less than 25%. Postinflammatory hyperpigmentation was observed in melasma. CONCLUSION: Intense pulsed light is an effective treatment for superficial melanocytic lesions; however, those with a deep component improve only if repetitive treatment sessions are applied.     

强脉冲光联合Q开关倍频Nd:YAG 532nm激光治疗面部雀斑疗效观察

目的:观察强脉冲光联合Q开关倍频Nd:YAG 532nm激光治疗面部雀斑的临床效果。方法:选取笔者医院2017年5月-2019年5月收治的126例雀斑患者,随机分为观察组和对照组,每组63例。对照组采用强脉冲光治疗,观察组采用强脉冲光联合Q开关倍频Nd:YAG 532nm激光治疗,观察两组治疗后的临床效果。结果:观察组临床总有效率明显高于对照组(χ^2=12.86,P<0.01),观察组治疗总次数明显低于对照组(t=3.928,P<0.05),复发率也明显低于对照组(χ^2=4.189,P<0.05),患者对治疗满意度明显高于对照组(χ^2=13.945,P<0.01),两组不良反应发生率无明显差异(χ^2=0.099,P>0.05)。结论:强脉冲光联合Q开关倍频Nd:YAG 532nm激光治疗雀斑复发率低、治疗次数少、安全性高,临床效果显著,值得在临床上推广使用。