Download 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:
1. 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
-melasma
-café au lait macules
-mottled pigmentation
-Ota’s, Ito’s naevus
-epidermal lentigines
-Becker’s and Spillus naevus
-ephelides
-seborhoeic keratoses
-lentigo solaris
-actinic keratoses
-postinflamatory
hyperpigmentation
-poikiloderma of Civatte
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)
THANK YOU!