Treatment of port-wine stains with a noncoherent pulsed light source: a retrospective study

Treatment of linear and spider telangiectasia with an intense pulsed light source

BACKGROUND

The flashlamp-pumped pulsed dye laser (585 and 577 nm) has proved to be an effective and safe treatment option in the therapy of linear and spider facial telangiectasia. Nevertheless, the postoperative purpura, which most patients see as cosmetically disfiguring, has always been a matter of concern.

AIMS

To test the effectiveness and safety of an intense pulsed light source (IPLS), which emits non-coherent light adjustable within the 515-1200 nm range, in the treatment of linear and spider facial telangiectasia.

PATIENTS & METHODS

One hundred and forty patients with linear and stellate facial telangiectasia were treated with an IPLS.

RESULTS

In 94 (67.1%) the results were considered excellent (clearance of 80-100%), 43 (30.7%) showed good results (clearance of 40-80%) and in 3 patients (2.1%) the results were poor (clearance < 40%). Post-treatment side effects were minimal and well tolerated. There were no instances of scarring or other permanent side effects. Owing to the large spot size, a large area could be treated within one session. No anaesthesia was required.

CONCLUSION

IPLS is a highly effective and comparably safe therapeutic alternative to the pulsed dye laser in the treatment of facial telangiectasia. The rate of cosmetically relevant side effects is considerably smaller, patient compliance is excellent and the method can easily be applied in an outpatient setting.

Recent advances in laser treatment of port-wine stains

The pulsed dye laser is the treatment of choice for port-wine stains, with proven efficacy and low incidence of side-effects. However, in the majority of cases complete clearance cannot be achieved, and a significant proportion of lesions is resistant to laser treatment. In recent years, increased understanding of the interaction between lasers and port-wine stains has led to modification of the original pulsed dye laser design, producing treatment responses even in those lesions resistant to first-generation pulsed dye lasers. Other lasers and noncoherent light sources also appear to have a potential role in treatment. In this review we discuss these recent developments.

Treatment of Port Wine Stains with Intense Pulsed Light: A Prospective Study

BACKGROUND

Recent studies have shown that intense pulsed light can be useful in treating port wine stains that were resistant to previous pulsed dye laser therapy. Asian persons with high epidermal melanin context can be at a higher risk of complication.

OBJECTIVE

The aim of this study was to conduct a prospective trial to assess the efficacy and complication of intense pulsed light in the treatment of port wine stains in Chinese patients.

METHODS

Twenty-two Chinese patients with port wine stains without previous treatment were recruited to receive intense pulsed light source therapy for five to seven treatments at intervals of 3 to 4 weeks. Patient demographics, skin type, characteristics of port wine stains including color and location, treatment parameters, degree of pain caused by intense pulsed light treatment, percentage of clearing, and treatment complications were recorded and entered into a database. A questionnaire was conducted to assess the influence of treatment on daily activity and the intensity of pain experienced during treatment.

RESULTS

There were 17 female and 5 male patients. Their ages ranged from 6 to 45 years with a mean age of 21.8+/-10.1 years. More than 90% of patients had more than 25% of clearing and the majority of patients (50%) had 25% to 50% of clearing. Although 40% of the patients showed more than 50% clinical clearance, 9% of the patients were able to achieve more than 75% clearing. The only 2 patients with less than 25% clearing had nodular port wine stains and no patient was able to achieve complete clearing. The procedures were well tolerated with a mean pain score of 2.1+/-0.9 and the treatment had no influence on daily activity. One patient developed blisters and 6 patients had swelling for more than 24 hr that all resolved within 1 week without leaving permanent marks. They have been followed up from 12 to 27 months and there was no long-term complication.

CONCLUSION

Intense pulsed light can be effective in treating port wine stains in Asian patients. In experienced hands, complications can be low and should be considered as one of the therapeutic options.

Hair reduction using intense pulsed light source

BACKGROUND

Long-term hair removal in hirsute women remains a challenging issue. Various laser and laser-like devices are currently in use for hair removal, but little is known about the permanence of their results. This study deals with the permanence of hair removal using the intense pulsed light source (IPLS).

OBJECTIVE

To test the effectiveness in long-term hair reduction.

METHODS

Seventy female hirsute patients were selected in the Department of Laser Therapy at the Medical Center, Maastricht, the Netherlands. The average age of the mostly dark-haired patients of various skin types (Fitzpatrick I to V) was 41 years. They were subjected to a mean of 8 treatments (range of 2 to 23) followed for a mean period of 27.3 months.

RESULTS

Using the IPLS, 87% hair removal was achieved, whereby the number of treatments correlated with the amount of hair lost. No correlation was found between hair removal and patient-related or technical data. Minimal side effects occurred in 10% of the patients.

CONCLUSION

The IPLS system with its broad range of technical variables is effective in achieving long-term hair removal.

Laser Treatment of Cutaneous Vascular Anomalies

BACKGROUND

Lasers and light-based therapy have been used to treat port-wine stains and hemangiomas for the past two decades.

METHODS AND RESULTS

Laser treatment produces dramatic clearing of port-wine stains with minimal scarring or epidermal damage, minimizes hypertrophy of lesions, decreases the risk of bleeding from pyogenic granlomas, and reduces the associated psychosocial morbidity. Lasers are used to halt the proliferation of the superficial component of hemangiomas, reduce the mass of the lesions, and to treat the vascular ectasia as well as the atrophic scarring that develops following involution.

CONCLUSION

Laser therapy provides a safe and effective modality with low morbidity for cutaneous vascular anomalies.

IPL technology: a review

BACKGROUND AND OBJECTIVES

Intense pulsed light (IPL) systems are high-intensity light sources, which emit polychromatic light. Unlike laser systems, these flashlamps work with noncoherent light in a broad wavelength spectrum of 515-1,200 nm. These properties allow for great variability in selecting individual treatment parameters and adapting to different types of skin types and indications. The purpose of this article was to critically review international medical publications of the many indication in which IPL technology can be used, including our own evaluations and experiences.

STUDY DESIGN/MATERIALS AND METHODS

The range of therapeutic uses for high-intensity flashlamps was reviewed, ranging from benign cavernous hemangiomas, benign venous malformations, essential telangiectasias, leg telangiectasias, poikiloderma of Civatte, and port-wine stains to pigmented lesions, cosmetically undesired hypertrichosis, and facial rhydids. The relative benefits and risks were discussed in detail and compared with other laser systems.

RESULTS

Because of the wide spectrum of potential combinations of wavelengths, pulse durations, pulse frequency, and fluences, a great deal of experience is required when using IPL technology. Proper patient selection and critical diagnostics serve to keep the adverse effects of the treatment to a minimum.

CONCLUSIONS

The distinctive technical conditions involved combine to make IPL technology an alternative and auxiliary treatment option to existing laser systems and conventional therapies.

Lasers in dermatology: four decades of progress

Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.

Prospective study on the treatment of postburn hyperpigmentation by intense pulsed light

BACKGROUND AND OBJECTIVES

Postburn hyperpigmentation is a common phenomenon among Asian especially over grafted areas and sometimes over donor sites and healed wounds without skin graft. This condition is difficult to treat and can cause severe psychological distress. Intense pulsed light (IPL) has been used to treat melanocytic lesions with promising result. The role of IPL in treating postburn hyperpigmentation has not been explored. The purpose of this study was to assess the efficacy and complication of IPL in the treatment of postburn hyperpigmentation prospectively.

STUDY DESIGN/MATERIALS AND METHODS

Nineteen Chinese patients with postburn hyperpigmentation were treated by IPL. There were 14 females and 5 males. Their age ranged from 8 to 51 years with a mean age of 29.4 +/- 11.6 years. The cutoff filters of 550, 570, and 590 nm were used for 3-7 treatments at intervals of 3-4 weeks. Patients were treated with an energy fluence of 28-46 J/cm(2), pulse width of 1.7-4 milliseconds, double pulse mode, and a delay of 15-40 milliseconds.

RESULTS

Treatment results and complications were evaluated and scored after each treatment. Over 78% of the patients showed more than 50% clinical clearance and nearly 32% of the patients were able to achieve more than 75% clearing. Although two patients had no clinical response, one patient had 100% clearing. Three patients developed blisters and one patient had erythema that all resolved within 1 week without leaving permanent marks. They have been followed-up from 11-32 months and there was no recurrence of the hyperpigmentation.

CONCLUSIONS

IPL is effective and safe in treating postburn hyperpigmentation in Asian patients.

Ocular complication of PhotoDerm VL therapy for facial port-wine stain

BACKGROUND

A case of focal damage to the iris with distortion of the pupil secondary to PhotoDerm therapy in a 2-year-old boy is reported.

OBJECTIVE

To study ocular complication of photoDerm VL therapy for facial port-wine stain. METHODS. : Observatory case report.

RESULTS

PhotoDerm VL therapy may damage ocular tissues.

CONCLUSION

Appropriate protection during the procedure is essential.

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.

Effects of intense pulsed light on sun-damaged human skin, routine, and ultrastructural analysis

BACKGROUND AND OBJECTIVE

New, non-ablative methods can be used in skin rejuvenation. Histologic analysis of non-ablative IPL effects on facial, sun-damaged skin.

STUDY DESIGN/MATERIALS AND METHODS

Five female subjects, wrinkle class I or II and Fitzpatrick skin types I, II, and III. IPL treatment: once monthly, 560-nm cut-off filters, spot size 8x35 mm, 28-36 J/cm. Routine histology or electron microscopy on 2-mm punches, before treatment and then 1 week, 3 months, and 12 months.

RESULTS

Pre-treatment specimens contained solar elastosis and perifollicular lymphoid infiltrates. Collagen and elastic fibers appeared unaffected by treatment. At 1-week, Demodex organisms appeared coagulated.

CONCLUSIONS

Under these conditions, IPL induces minimal morphologic changes in mildly sun-damaged skin. Some esthetic improvement may be secondary to clearing of Demodex organisms and reduction of associated lymphocytic infiltrate.

Gross and microscopic findings in patients submitted to nonablative full-face resurfacing using intense pulsed light: a preliminary study

BACKGROUND

Intense pulsed light (IPL) is a noncoherent, nonlaser, filtered flashlamp emitting a broadband visible light that has been shown to be effective in photoepilation, as well as in a number of vascular and pigmented lesions of the skin. Their efficacy has also been reported recently in the treatment of photodamaged facial skin. In the last condition, however, there are few studies showing the clinical and microscopic changes produced by IPL.

OBJECTIVE

To assess the gross and microscopic changes that occur in photodamaged skin submitted to nonablative full-face resurfacing (NAFFR) using IPL.

METHODS

Five women were submitted to five NAFFR sessions using IPL, one every 2 weeks. Skin biopsies and photographs were taken on all of the patients before the first procedure and after the last one, as well as weekly clinical assessment. Data concerning skin features (wrinkles, oiliness, thickness, dilated pores, and general appearance) were all assessed. Microscopic improvement of the aging features in the epidermis and dermis were all assessed. For the statistical analysis a t test for small samples was used.

RESULTS

All the patients showed clinical and microscopic improvement in every one of the parameters assessed. The t test for small samples showed a statistically significant difference (P < 0.01) in epidermal thickness.

CONCLUSION

Facial photodamage was clinically and microscopically improved using IPL. Use of IPL as a rejuvenating method seems to be promising, with minimal side effects, a wide safety margin, and minimal downtime.

Full-face photorejuvenation of photodamaged skin by intense pulsed light with integrated contact cooling: initial experiences in Asian patients

BACKGROUND AND OBJECTIVES

For Asian skin, recent "non-ablative" skin rejuvenation techniques have become the focus of attention for darker complected patients. In our earlier research, we have shown that intense pulsed light (IPL) technology can be applied to Asian skin with a high degree of safety and efficacy. In this study, we performed full-face photorejuvenation using a new IPL device incorporating a 560 nm filter and integrated contact cooling system for the improvement of various symptoms associated with photoaging in Asian patients.

STUDY DESIGN/MATERIALS AND METHODS

A total of 73 patients were treated with a series of five or more full-face treatments at 3-4 week intervals using IPL with integrated contact cooling. One month after the third and fifth treatments, the patient and the treating physicians subjectively evaluated improvement in five areas-in pigmentation, telangiectasia, fine wrinkles, skin texture, and over-all improvement. In addition, histological changes were evaluated.

RESULTS

Pigmentation improvement, telangiectasia reduction, fine wrinkle reduction, smoother skin texture, and over-all improvement were evaluated according to five grades of percentage improvement. In addition, the subjective rating by the patients and the physicians was averaged, and the combined results were evaluated. After the fifth treatment, a combined rating of greater than 60% improvement was given to more than 80% of patients for pigmentation improvement, telangiectasia reduction or removal, smoother skin texture, and overall improvement. Histological evaluations showed strong staining of Type I and Type III collagen. Complications were minor and transitory, with burning sensations and erythema in only two patients.

CONCLUSION

Full-face photorejuvenation for Asian patients using this device is not only effective but is also associated with fewer post-treatment complications than other more invasive modalities. We conclude that IPL photorejuvenation can be the basis for safe and effective skin rejuvenation in Asian patients.

Lasers in dermatology. An overview of types and indications

Advances in laser technology have been so marked over the past two decades that successful eradication of many cutaneous pathologies and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair, can now be fully realized. Because of the relative ease with which many of these lesions can be removed, coupled with a low incidence of adverse postoperative sequelae, demand for laser surgery has increased substantially. In this review, the currently available laser systems with cutaneous application are outlined, with special reference to recent advancements and modifications in laser technology that have greatly expanded the laser surgeon's armamentarium and improved upon overall treatment efficacy.

Photorejuvenation for Asian skin by intense pulsed light

BACKGROUND

Dermabrasion and deep chemical peeling are used in the treatment of photoaged skin. These ablative procedures are effective enough to produce a certain improvement but have often caused postinflammatory hyperpigmentation among Asian patients. To avoid such adverse effects, a new, nonablative procedure has been sought.

OBJECTIVE

To determine the effectiveness of photorejuvenation for Asian skin using intense pulsed light (IPL). The specific parameters used, improvement ratios, side-effects, and downtime required are also discussed.

METHODS

Ninety-seven patients were treated for photoaging using IPL. The cutoff filters of 550 nm and 570 nm were utilized for three to six treatments at intervals of 2 to 3 weeks.

RESULTS

Treatment results were evaluated and rated by both patients and physicians at the end of the third treatment based on improvement in pigmentation, telangiectasia, and skin texture. A combined rating of "good" or "excellent" was given to more than 90% of the patients for pigmentation, more than 83% for telangiectasia, and more than 65% for skin texture. There were some minor complications in four cases: one had erythema that continued to the next day and three had minor blisters leaving no marks.

CONCLUSION

Photorejuvenation using IPL is a completely safe and effective procedure even for Asian skin. It will be increasingly used for skin rejuvenation in the future.

New approaches to the treatment of vascular lesions

BACKGROUND AND OBJECTIVE

The pulsed dye laser was developed based on the concept of selective photothermolysis. By using a wavelength of light well absorbed by the target and pulse duration short enough to spatially confine thermal injury, specific vascular injury could be produced.

STUDY DESIGN/MATERIALS AND METHODS

Although the pulsed dye laser revolutionized the treatment of port wine stains (PWS) and a variety of other vascular lesions, the ideal thermal relaxation time for the vessels in PWS is actually 1-10 ms, not 450 micros of the original pulsed dye laser machines. These original theoretical calculations recently have been proven correct in a study that used both an animal vessel model and in human PWS.

RESULTS

Longer wavelengths of light, within the visible spectrum, penetrate more deeply into the skin and are more suitable for deeper vessels, whereas longer pulse durations are required for larger caliber vessels.

CONCLUSION

A variety of lasers recently have been developed for the treatment of vascular lesions which incorporate these concepts into their design, including pulsed dye lasers at 1.5 ms, a filtered flash-lamp pulsed light source with pulse durations of 1-20 ms, several 532-nm pulsed lasers with pulse durations of 1 ms to as high as 100 ms, long pulsed alexandrite lasers at 755 nm with pulse durations up to 20 ms, pulsed diode lasers in the 800 to 900 nm range, and long pulsed 1064 Nd:YAG sources.

New approaches to the laser treatment of vascular lesions

The pulsed dye laser (PDL) was developed based on the concept of selective photothermolysis. Using a wavelength of light well absorbed by the target and a pulse duration short enough to spatially confine thermal injury, specific vascular injury could be produced. While the PDL revolutionized the treatment of port wine stains (PWS) and a variety of other vascular lesions, the mathematical model predicted that the ideal thermal relaxation time for the vessels in PWS is actually 1-10 msec, not 450 microseconds. These original theoretical calculations have been proved correct recently in a study using both an animal vessel model and in human PWS. Longer wavelengths of light within the visible spectrum penetrate deeper into the skin and are more suitable for deeper vessels; while longer pulse duration is required for larger calibre vessels. A variety of lasers have been developed recently for the treatment of vascular lesions that incorporate these concepts into their design, including PDL at 1.5 msec, a filtered flash-lamp pulsed light source with pulse durations of 1-20 msec, several 532 nm pulsed lasers with pulse durations of 1 to as high as 100 msec, long pulsed alexandrite lasers at 755 nm with pulse durations up to 20 msec, pulsed diode lasers in the 800-900 nm range, and long pulsed 1064 Nd:YAG sources. Preliminary results are encouraging.