Intense pulsed light ipl in dermatology
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INTENSE PULSED LIGHT (IPL) IN DERMATOLOGY. Dr. Ruxandra Cutus Dr. Razvan Bucur Cabinet SANDERM-Cluj. Intensed pulsed light (IPL) systems are high intensity light sources which emit : polychromatic light; noncoherent light; broad wavelength spectrum ( 515-1200 nm)

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Intense pulsed light ipl in dermatology

INTENSE PULSED LIGHT (IPL) IN DERMATOLOGY

Dr. Ruxandra Cutus

Dr. Razvan Bucur

Cabinet SANDERM-Cluj


  • Intensed pulsed light (IPL) systems are high intensity light sources which emit :

  • polychromatic light;

  • noncoherent light;

  • broad wavelength spectrum ( 515-1200 nm)

  • visbile light (white light)+ IR light

  • LASERS( Light Amplification by the Stimulated Emission of Radiation) emit :

  • monochromatic light (single wavelength)

  • coherent light

  • Light and LASER beams are all forms of electromagnetic radiation


  • Adjustable IPL’s parameters:

  • energy-Joule

  • fluence-Joule/cm2=density of energy

  • filters-550, 560, 640nm

  • pulses parameters:-number of pulses(1-5)

  • -pulse duration(2-7ms)

  • -pulse delay(1-300ms)

  • Light Absobtion in Tissue- by the two natural cromophores: hemoglobin(580 nm) and melanin(400-750nm)

  • Light Tissue Effects-Photothermolysis=the matching of a specific wavelength, pulse duration and filter to obtain optimal effect on a targeted tissue with minimal effect to surounding tissues

  • Examples: - hair removal

  • -vascular lesions-thermocoagulation

  • -pigmented lesions-photorejuvenation (+ dermal remodelling by activation of cytokine and growth factors+increased production of colagen 1)


  • Historical data:

  • 1976- Muhlbauer- first description of thermocoagulation of capillary hemangiomas and port-wine stains by means of polychromatic light

  • 1994-first market ready system, Photoderm( Lumenis Ltd., Israel)

  • -organised in programs

  • for hair removal-short (F I-II), medium (F II-IV) and long (F V-VI)-depending on Fitzpatrick types of skin

  • for skin rejuvenation(vascular pigmented lesions)-program 1 ( F I-II ); program 2( F II-IV ); program 3 ( F V-VI )

  • -different heads with different filters(560, 595, 640, etc) allowing to treat different body areas, different depths of skin lesions, different Fitzpatrick phototypes, different target structures


  • INDICATIONS:

  • HAIR REMOVAL

  • -one of the most important indications of IPL

  • -photothermolysis induces damage to the hair follicle and hair shaft in anagen phase causing a long term interruption in the hair growth cycle

  • -for localised hypertrychosis; hairy grafts and flaps; hirsutism; aesthethic purposes

  • -6-8 treatments at 6 weeks interval

Advantages:

-quick spot size

-little pain

-efficiency (studies reveal 80-90% clearance rate after 4-8 treatments)

-safe-few side effects

Possible side effects:

-transient erythema(2-48 hours ± oedema

-late evanescent erythema

-mild pain; purpura-1-3 days

-crust formation; isolated vesicles

-transient hyper/hypopigmentation

-permanent scars are unlikely


2.PIGMENTED LESIONS

-café au lait macules

-Ota’s, Ito’s naevus

-Becker’s and Spillus naevus

-seborhoeic keratoses

-actinic keratoses

-poikiloderma of Civatte

-melasma

-mottled pigmentation

-epidermal lentigines

-ephelides

-lentigo solaris

-postinflamatory hyperpigmentation

Mechanisms-melanosomes damaged by photothermolysis→melanin aggregates→macrophage transport

Advantages:-quick-1-5 sessions( frequent 1-3), 3 weeks apart )

-minimal disconfort

-lunch-time treatments

-efficiency

-safety-minimal or no side effects

-all facial and non-facial areas can be treated


1.

2.


  • 3.BENIGN VASCULAR LESIONS

  • -cuperosis( eythemato-telangiectatic rosacea )

  • -rosacea ( papulo-pustulous- demodex destruction )

  • acne and erythema associated with acne

  • -essential telangiectasias

  • hemangiomas

  • poikiloderma of Civatte

  • leg telangiectasias ( red, under 1 mm diameter )

  • venous malformations (ex. blue rubber bleb naevus)

  • erythematous stretch-marks


4.SKIN REJUVENATION

-non-ablative skin-rejuvenation or “subsurfacing”-rhytides

-good effect( better when associated IPL+RF or IPL+IR )

-improvement in the quality of skin-no total resolution

-Mechanism: dermal remodelling occurs through increasing collagen 1 deposits, with collagen reorganisation into parallel arrays of compact fibriles

-general skin rejuvenation for face, neck, decoltaeum area: minimising the pores; coagulation of the dilated vessels; dissapearance of pygmentary spots


  • 5.SCARS

  • -very good results; IPL treats:

  • hypertrophic scars ( post trauma; post surgery; post combustion )

  • atrophic erythematous scar ( post acne )

  • keloids ( post trauma; post surgery; post combustion and so on )


1.Acute episode

2.Keloids and Hypertrophic Scars ; Postinflamatory hyperpigmentation


3.During the first treatments

4. End of the treatment


  • CONCLUSIONS: IPL treatments are:

  • successful and non-invasive means of treatment

  • a very good alternative to conventional therapeutic options

  • particularly useful for hair removal; cuperosis; scars and angiomas

  • low rate of side effects

  • high levels of patient satisfaction

  • because of the wide range of potential combinations of wavelength, pulse durations, pulse frequency and fluences, working with IPL is a complex matter (lack of proper legislation)

  • can be used for better results in aesthetic medicine in combination with: botulinum toxin, fillers, Nd:YAG LASERS ( especially for angiomas and telangiectasis ), microdermabrasion or chemical peeling, aesthetic surgery

  • the spectrum of possible indications is continuously increasing( ex: IPL+ aminolevulinic acid for treatment of actinic keratosis or superficial basal cell carcinoma)



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