Treatment of venous malformations with an intense pulsed light source (IPLS) technology: A retrospective study

Assessment of adverse events for a home-use intense pulsed light hair removal device using postmarketing surveillance

BACKGROUND AND OBJECTIVES

Home-use intense pulsed light (IPL) hair removal devices are convenient for consumers. Consumer safety associated with home-use IPL devices, however, remains a subject of interest. In this descriptive analysis, we assessed the most commonly reported adverse events (AEs) for a home-use IPL device from postmarketing surveillance and qualitatively compared these with AEs from clinical studies and medical device reports of home-use IPL treatments.

MATERIALS AND METHODS

For this analysis of voluntary reports, we queried a distributor's postmarketing database for IPL devices for the period beginning January 1, 2016, to December 31, 2021. All sources of comments, for example, phone, e-mail, company-sponsored web sites, were included in the analysis. AE data were coded according to the Medical Dictionary for Regulatory Activities (MedDRA) terminology. Also, we conducted a PubMed search to identify AE profiles from existing literature on home-use IPL devices and we searched the Manufacturer and User Facility Device Experience (MAUDE) database for reports on home-use IPL devices. These results were qualitatively compared to the data in the postmarketing surveillance database.

RESULTS

A total of 1692 cases involving IPL were identified from voluntary reports of AEs between 2016 and 2021. The shipment-adjusted reporting rate for AE cases (number of AE cases/100,000 shipped IPL devices) was 67/100,000 during this 6-year period. The most commonly reported AEs were pain of skin 27.8% (470/1692), "thermal burn" 18.7% (316/1692), and erythema 16.0% (271/1692). Among the top 25 AEs reported, no unexpected health events were observed. The reported AEs were qualitatively similar to the pattern seen in clinical studies and the MAUDE database associated with such home-use IPL treatments.

CONCLUSION

This is the first such report documenting AEs for home-use IPL hair removal from a postmarketing surveillance program. These data are supportive of the safety of such home-use low-fluence IPL technology.

Management strategy for facial venous malformations

Venous malformations (VMs) are slow-flow vascular malformations, caused by abnormalities in the development of the veins. Venous malformations vary in size and location within the body. When the skin or tissues just under the skin are affected, they appear as slightly blue-colored skin stains or swellings. These can vary in size from time to time because of swelling within the malformation. As these are vascular malformations, they are present at birth and grow proportionately with the child. Venous malformations can be very small to large in size, and sometimes, can involve a significant area within the body, When the venous malformation is well localized, this may cause localized swelling, however, when the venous malformation is more extensive, there may be more widespread swelling of the affected body part. Some patients with venous malformations have abnormal blood clotting within the malformation. Most venous malformations cause no life-threatening problems for patients. Some venous malformations cause repeated pain due to intermittent swelling and congestion of the malformation or due to the formation of blood clots within the malformation. Rarely, venous malformations may be part of a syndrome (an association of several clinically recognizable features) or be linked to an underlying genetic abnormality. We present 12 cases of venous malformations of the head and neck area, which have been managed at our hospital.

Intense pulsed light treatment for chronic facial erythema of systemic lupus erythematosus: a case report

BACKGROUND

A 33-year-old woman, who had been diagnosed previously with systemic lupus erythematosus, presented with chronic erythema and rosacea of the face. The patient suffered from flushing and burning of the facial skin and sought prior treatment with anti-malarial drugs.

METHOD

After various treatment options were discussed with the patient, she agreed to undergo intense pulsed light therapy.

RESULTS

Improvement was noted after the first session and 75% clearance was observed at 1 month after a second session. There were no adverse effects associated with the treatment. One year later it was observed that the results of the two treatments had been maintained.

CONCLUSION

This case report suggests that there is another safe and efficacious alternative for treatment of chronic erythema and rosacea.

Hand rejuvenation using intense pulsed light

BACKGROUND

The aging of the hands is typically characterized by wrinkles, skin thinning, and solar lentigines. The search for effective treatments has led to the use of laser and intense pulsed light (IPL) technologies.

OBJECTIVE

To assess the effectiveness of an IPL device for the improvement of dyspigmentation and overall skin quality on the dorsa of the hands.

METHODS

Twenty-three patients with sun damage and solar lentigines on the dorsal hands were treated with four IPL sessions at 3- to 4-week intervals. Prior to treatment, photographs were taken and informed consent was obtained. Pre- and post-treatment photography and investigator clinical assessment and patient questionnaires were collected for data analysis.

RESULTS

After four treatment sessions, good to excellent results in the improvement in solar lentigines and skin quality were assessed by investigators in 100% of the cases and in 86.94% (20 of 23 subjects) by patient self-assessments. No significant side effects were observed.

CONCLUSION

IPL is an effective and safe treatment option to improve solar lentigines and skin texture for hand rejuvenation.

Soft tissue tumors of the hand. 1. Benign

Soft tissue tumors of the hand arise from skin, subcutaneous tissue, tendons, nerve, and blood vessels. Many of these lesions occur on other parts of the body; however, the hand remains a unique site because these tumors have symptoms, appearances, treatments, and prognoses that may be quite different than when on other parts of the body. Their characteristics and the severity of symptoms vary markedly depending on the exact location, size, and type of tumor-and many of these tumors can have multiple forms of presentation. Two articles are intended to provide an overview of benign (this article) and malignant tumors (subsequent issue) of the hand. The rarer and more deleterious tumors are discussed in detail while the common tumors and epidermal lesions with which practitioners are familiar are briefly overviewed. At the completion of these review articles, participants should be able to identify and diagnose various benign and malignant hand tumors as well as understand the accepted current treatment of these growths.

[Venous lakes. Treatment with a combination of diode laser (910 nm) and radio frequency]

BACKGROUND

Venous lakes of the lip are a cosmetic problem for many patients due to their exposed location, nodularity, fragility and blue color. We sought an effective and well tolerated therapy method.

PATIENTS AND METHODS

Over one year, we treated 20 patients with a combination of diode laser (910 nm) and radiofrequency.

RESULTS

In all cases, there was complete regression of the venous lake (average: 1.4 treatment sessions). Side effects were transient pain that was assessed as mild by the patients, and transient swelling. Scarring or hypo-/hyperpigmentation did not occur.

CONCLUSION

This combined approach is a recommended option at least equivalent to other therapy methods (argon laser, CO(2) laser, pulsed-dye-laser, and others), or even superior to them due to the low rates of side effects and low number of treatment sessions.

Laser therapy of vascular lesions

Since the first construction of a laser by Maiman in 1960 and the first clinical application of a laser in the therapy of skin lesions by Leon Goldman, laser therapy has become an important therapeutic modality in dermatology. Various lasers can be used for the treatment of different vascular and non-vascular lesions. According to our results, vascular lesions constitute the most important indication for laser therapy in dermatology.

Laser Treatment of Venous Malformations

Venous malformations (VM) are developmental errors comprised of enlarged dysplastic blood vessels. Clinically they manifest as either a faint blue patch or a soft blue vascular mass. Treatment options include a sclerosing agent (such as alcohol or ethiblock), surgery or laser therapy. A review of the literature concerning VM and laser treatment yielded a few sporadic reports describing series of 3 to 46 cases. In this retrospective study we reviewed the files of the relevant cases. The data included the extent of the lesion, the different anatomical sites, age of patient and the extent of clearance of the lesion as the treatment's end point. This study includes 56 cases which makes it the largest series presented. The success rate of laser treatment was 92.8%. The immediate complication rate was very low (approximately 3.57%) including minimal scarring and deformity. No long term complications were noted. Our study concludes that treatment of VM is a difficult task due to the nature of the lesions. Laser treatment of these lesions enables one to obtain good results with a very low incidence of complications. Surgery and other treatment modalities are not always satisfactory, yield similar or less efficient results and have a higher complication rate. Laser treatment can play an important role in the treatment of VM and in fact may be the treatment of choice in some settings.

Laser- und Lichttherapie von vaskulären Hautveränderungen

The use of lasers to treat vascular lesions began in the late 1960s with the introduction of argon laser. More recently pulsed laser and intense pulsed light techniques have further improved results and reduced side effects. Their function is based on the principle of selective photothermolysis. Simultaneous application of cooling methods (contact cooling, cold air, cryogen spray) has become standard procedure for these types of therapy, whose most important indications are port-wine stain, hemangioma, and telangiectasia. A persistent difficulty is their limited penetration, resulting in limited or no effect on deeper dermal layers. New approaches therefore include combinations with bipolar radio frequency or the use of two different laser systems, e.g., dye and Nd:YAG lasers. The different lasers are described along with their effectivity, limitations and indications.

Treatment of Facial Venous Malformations with Combined Radiofrequency Current and 900 nm Diode Laser

BACKGROUND

Laser treatment of venous malformations is a major challenge because of the large variations in skin pigmentation, anatomic location, and vessel size and depth.

OBJECTIVE

To determine the safety and effectiveness of electro-optical synergy, a new technology that combines the 900 nm diode laser with radiofrequency current for the treatment of facial venous malformation.

METHODS

Fourteen patients with Fitzpatrick skin types II to IV were treated for facial venous malformations with simultaneous radiofrequency energy (60-80 J/cm3) and optical diode laser energy (fluence 80-100 J/cm2) in one to three sessions. All lesions measured less than 100 cm2. Lesion clearance was evaluated by three specialists on the basis of digital photographs taken before the first treatment and 1 and 2 months after the last treatment.

RESULTS

Thirteen patients showed a complete response and one patient a partial response. The results were rated excellent in the 13 patients and good in one patient. Transient swelling, erythema, and pain were present in all patients, with permanent scarring in only one patient.

CONCLUSION

The combination of laser light and radiofrequency energy is effective and safe for the treatment of facial venous malformations. It provides additional heating of the vessels without increasing laser intensity. The side effects are minimal.

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.

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.

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.