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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

slide2

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
slide3

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)
slide4

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
slide5

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

slide8

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

slide11

1.

2.

slide12

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
slide16

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

slide18

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 )
slide19

1.Acute episode

2.Keloids and Hypertrophic Scars ; Postinflamatory hyperpigmentation

slide20

3.During the first treatments

4. End of the treatment

slide21

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)