Intense Pulsed Light Sessions Research Articles

Novel treatment of nail psoriasis using the intense pulsed light: a one-year follow-up study.

Pulsed dye laser has been used successfully in the treatment of nail psoriasis. Intense pulsed light (IPL) has been used in the treatment of plaque psoriasis using a 550-nm filter. To study the efficacy of IPL in the treatment of nail psoriasis. Twenty patients with finger and toe nail psoriasis were treated by IPL. Sessions were performed every 2 weeks for a maximum of 6 months. The Nail Psoriasis Severity Index (NAPSI) score was calculated at baseline and 1 month after the last treatment session. Follow-up was performed at 1, 6, and 12 months. Patients received a mean of 8.63 ± 3.6 IPL sessions. After treatment, there was significant improvement in the nail bed and matrix (p < .0001), and in the NAPSI (p < .0001). Nail bed showed improvement by 71.2%, whereas the nail matrix improvement was only 32.2%. The total NAPSI was 82.4%. Patient follow-up revealed relapse in 3 patients after 6 months. Intense pulsed light is a promising effective modality of treatment of nail psoriasis, which is easy to use, safe, and provide a long period of remission. This was confirmed by the elicited clinical improvement, NAPSI, and patient satisfaction.

A comparative study of the effectiveness of intense pulsed light wavelengths (650 nm vs 590 nm) in the treatment of striae distensae

Background and objectives: Striae distensae (SD) are a common skin condition that is a significant source of psychological distress. Intense pulsed light (IPL) may play a role in the management of the disease. The purpose of this study was to compare the effect of two wavelengths of IPL (650 nm vs 590 nm) in the treatment of SD. Patients and methods: Twenty patients with SD were included. Five sessions of IPL were carried out in each patient at 2-week intervals. Each side of the body was treated with a single wavelength. The response to the therapy was evaluated 2 months after the last session. Patients’ satisfaction was also used in the assessment. Results: The reduction in the sum of lengths and maximum width on both sides was statistically highly significant (p < 0.0001). The reduction in the degree of erythema was statistically significant only when the wavelength of 590 nm was used (p = 0.0157). The patient satisfaction was better when the wavelength of 590 nm was used. All side effects were transient and well tolerated. Conclusion: The study showed that IPL is a good option for the treatment of SD and the wavelength of 590 nm was more effective than the wavelength of 650 nm.

A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism*

Objective: We sought to determine whether topical finasteride can enhance the efficacy of intense pulsed light hair removal. Materials and methods: An intense pulsed light (IPL) treatment with radiofrequency (RF) was performed every four weeks, resulting in up to three sessions, and again at the end of the study – 6 months after the start of the experiment. Each patient also applied either finasteride or placebo solution twice daily to each side of the chin in a double-blinded manner. Results: A total of 77 patients were included in the study. Mean hair density before treatment in finasteride side of the patient's chin was 19.7 ± 11.7 and in placebo side was 19.1 ± 11.3. After three sessions of IPL + RF treatment, combined with twice daily application of finasteride and placebo solutions, at the end of 6-month period mean hair density of 8 ± 6.3 and 9 ± 5.6 was achieved in finasteride and placebo side respectively. Statistically significant difference was found between finasteride and placebo solution. Conclusions: We have demonstrated that the addition of finasteride solution to IPL + RF hair removal may result in a more reduction of unwanted facial hair in women when the combination is used for up to 6 months.

Histopathologic Changes Induced by Intense Pulsed Light in the Treatment of Poikiloderma of Civatte

The clinical efficacy of intense pulsed light (IPL) in the treatment of poikiloderma of Civatte (PC) is well documented, but little is known about microscopic changes. To analyze histopathologic findings on the necks of individuals with PC after IPL therapy. Fourteen patients with PC on the neck underwent three monthly sessions of IPL. Biopsies and clinical photographs were taken before and 60days after treatment. A dermatopathologist analyzed histopathologic slides stained with hematoxylin and eosin, Masson's trichrome, Verhoeff-van Gieson and Fontana-Masson or processed for CD-34 immunohistochemistry. The slides also underwent digital image analysis. Clinical results were based on the analysis of the pictures by three dermatologists and on patient satisfaction. Intense pulsed light treatment resulted in more-homogeneous melanin distribution; a greater number of fibroblasts and nonfragmented elastic fibers; and greater density (p=.01), color intensity (p=.02), number and thickness of the collagen bundles. No significant changes in vessels' number or diameters were observed. Clinical results were positive in 92.9% of the cases. IPL treatment of PC induced a more-homogeneous distribution of melanin and increased nonfragmented elastic fibers, collagen density, and intensity. These changes were related to clinical improvement.

Efficacy of intense pulsed light combined with topical erythromycin solution 2% versus topical erythromycin solution 2% alone in the treatment of persistent facial erythematous acne macules

Background:There is always a necessity for newer acne treatments. Intense pulsed light (IPL) technology has been used for this purpose but there are limited studies in this field. As macular and erythematous remnants of acne inflammatory lesions are very common, resistant, and long lasting, we decided to evaluate the efficacy of IPL (as a tool for diminishing erythematous reactions in the tissues) for the treatment of residual erythematous macules following facial acne.Materials and Methods:Thirty-five patients were registered in the study. Patient recruitment occurred between January 2010 and June 2011, and the study was completed in October 2011. Every patient received three IPL sessions, with a 2 week interval, on the right side of his/her face. Also, we recommended the patients to apply topical erythromycin solution 2% twice daily on their entire face from start to end of the study (i.e. until 3 months after the third IPL session). An independent physician counted the number of erythematous macules before every IPL session and 1 and 3 months after the last session.Results:Thirty-three patients completed the study and were enrolled in analysis. Results of the study show that IPL therapy decreases the number of erythematous macules along the time.Conclusions:IPL can accelerate the improvement rate of persistent erythematous macules remained after inflammatory acne subsides. More studies are needed to explain the exact role of it.

Laser and intense pulsed light management of couperose and rosacea

Management of couperosis and rosacea has been totally renewed by laser and vascular laser techniques, with efficacy targeted on the telangiectases and to a lesser extent on the erythrosis. Laser management of hypertrophic rosacea or rhinophyma depends on surgical treatment with decortication, continuous CO(2) ablative laser or Erbium, fractionated at high power, then vascular laser treatment for the telangiectases: lasers with pulsed dye, KTP, or pulsed lights for red laser telangiectases and long pulse Nd-Yag laser for blue telangiectases. For papulopustular rosacea, vascular laser treatment (pulsed dye and KTP) and intense pulsed light will be begun once the inflammation has been treated. The major indication for vascular lasers and intense pulsed light is found in erythematotelangiectatic rosacea, with high efficacy for the telangiectases. Diffuse erythrosis is difficult to treat, requiring a high number of laser and/or intense pulsed light sessions.

Prise en charge par laser et lampes pulsées de la couperose et de la rosacée

Management of couperosis and rosacea has been totally renewed by laser and vascular laser techniques, with efficacy targeted on the telangiectases and to a lesser extent on the erythrosis. Laser management of hypertrophic rosacea or rhinophyma depends on surgical treatment with decortication, continuous CO(2) ablative laser or Erbium, fractionated at high power, then vascular laser treatment for the telangiectases: lasers with pulsed dye, KTP, or pulsed lights for red laser telangiectases and long pulse Nd-Yag laser for blue telangiectases. For papulopustular rosacea, vascular laser treatment (pulsed dye and KTP) and intense pulsed light will be begun once the inflammation has been treated. The major indication for vascular lasers and intense pulsed light is found in erythematotelangiectatic rosacea, with high efficacy for the telangiectases. Diffuse erythrosis is difficult to treat, requiring a high number of laser and/or intense pulsed light sessions.

Original Contribution: Hyperandrogenism does not predispose patients to photoepilatory treatment failure: a single‐center review

SummaryStudies have suggested that patients with PCOS tend to be more treatment resistant to light‐mediated depilation compared with their non‐PCOS counterparts. We conducted a retrospective assessment of 29 hirsute patients treated between January 2006 and February 2007 to assess whether those with unsatisfactory hair clearance after treatment with intense pulsed light (IPL) were predominantly hyperandrogenic. The number of IPL sessions was also recorded for those patients failing to improve on treatment. Seventy‐six percent had satisfactory hair clearance where hyperandrogenic patients dominated. All patients required an average of six treatments before discharge. Eighty‐eight percent of poor responders were normoandrogenic. Our hyperandrogenic cohort appeared more responsive to IPL than the normoandrogenic patients. From our observations, the presence of hyperandrogenism does not indicate treatment resistance. This standpoint is unique and warrants a randomized trial directly comparing the two groups to investigate whether a positive or negative relationship actually exists.

Efficacy of IPL in treatment of acne vulgaris : Comparison of single- and burst-pulse mode in IPL

Background:Intense pulsed light (IPL) has been used for the treatment of facial acne. Modifications of various parameters allow flexibility in treatment, which include energy fluence, pulse duration, and pulse delay. We compared the efficacy of burst-pulse (multiple pulse) mode with single-pulse mode in treatment of acne.Objective:This study was designed to evaluate the efficacy of the IPL in treatment of facial acne and to compare burst-pulse and single-pulse mode in treatment of acne.Materials and Methods:Ten patients with facial acne were subjected to monotherapy with IPL. Baseline grading of acne was done with Michelsons acne severity index; however, right and left side of face were scored separately and a total score was also taken. IPL was administered once weekly for four sessions. Right side was subjected to IPL with burst-pulse mode, and left side was subjected to single-pulse mode. Severity score assessed after the end of treatment. Clinical photographs were also obtained for evaluation.Results:All patients revealed a reduction in number of acne for both single- and burst-pulse mode treated sides. The mean total score was 49.4 at baseline and showed 49.19% reduction after four sessions of IPL. Burst-pulse mode treated side showed a better control than that of single-pulse mode.Conclusion:IPL as a monotherapy showed beneficial effect in treatment of facial acne. Burst-pulse mode was better than the single-pulse mode in clearing acne.

A Comparative Study of Topical 5-Aminolevulinic Acid Incubation Times in Photodynamic Therapy with Intense Pulsed Light for the Treatment of Inflammatory Acne

Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) is used for effective treatment of facial acne vulgaris. To determine which of two different incubation times (30 minutes and 3 hours) is more effective in PDT with intense pulsed light (IPL) for acne vulgaris. Twenty Korean subjects with moderate to severe acne were enrolled for a randomized, half-facial treatment study. Three sessions with short incubation with ALA plus IPL (30 minutes, n=9) or long incubation with ALA plus IPL (3 hours, n=11) on one side of the face and IPL alone on the other side were performed at 1-month intervals. All subjects showed improvement in inflammatory acne lesions after three sessions of ALA-PDT or IPL alone (p<.001 in all groups). The degree of improvement in inflammatory acne lesions was greater in the long incubation time group than the short incubation time group or the IPL-alone group, although the mean reduction of inflammatory acne lesions was statistically different only between the long incubation group and the IPL-only group (p=.01). There were no statistical differences between the short incubation group and IPL-alone group. All three groups had decreased sebum secretion after three sessions (p<.001 in all groups), but the differences between groups were not statistically significant. Only transient erythema and mild edema were reported for all treatment groups. PDT with a long ALA incubation time might be more adequate for a pronounced outcome with inflammatory acne.

Treatment of facial flushing by topical application of nicotinic acid cream followed by treatment with 595-nm pulsed-dye laser

Conflict of interest: none declared. A 26‐year‐old Korean man presented with facial flushing that was easily aggravated by various conditions including emotional stress and hyperthermic stimulation. He had been treated with four sessions of intense pulsed light at private dermatological clinic without achieving satisfactory improvement. There was no pertinent personal or family history. Informed consent was obtained from the patient for treatment with a 595‐nm pulsed‐dye laser (PDL) (Vbeam®; Candela Corporation, Wayland, MA, USA) and three sessions were performed. Before each treatment, the symptoms were provoked by application of topical nicotinic acid cream (Litederm™ nicotinic acid laser preparation cream; Beauté Pacifique, Hadsund, Denmark), a vasodilator of the superficial cutaneous vasculature, which was left on the skin for 20 min (Fig. 1a). After application of the topical agent, the patient reported a mild to moderate burning sensation, but no itching or prickling sensations. The affected areas were first treated with nonoverlapping single pulses of the 595‐nm PDL (fluences of 6.5–7.5 J/cm2, spot size 10 mm, pulse duration 6–10 ms). An integrated dynamic cooling device with a setting of 30 ms on/30 ms off was applied to cool the epidermis. After the procedure, the face was completely cleansed with a mild cleanser. The redness induced by the topical agent and laser irradiation spontaneously resolved within 2 h.

Increased Insulin Sensitivity by Metformin Enhances Intense-Pulsed-Light-Assisted Hair Removal in Patients with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is an insulin-resistant state with hirsutism as a common manifestation. Objective: We hypothesized that treatment with metformin would improve the cosmetic effects of intense pulsed light (IPL) therapy for hair removal in PCOS patients. Methods: In a prospective randomized controlled trial, 70 PCOS patients randomly received metformin (1,500 mg daily) + IPL therapy or IPL therapy alone for 5 IPL sessions during a 6-month period, followed by an additional 6 months of observation. Hirsutism score, homeostasis model assessment for insulin resistance (HOMA-IR), free androgen index (FAI) and patient satisfaction were evaluated at every visit. Results: Fifty-two patients finished the study. Hirsutism was significantly better controlled in the metformin group (p = 0.009). Patient satisfaction was significantly better in the metformin group at the end of the observation period (52.9 vs. 34.1%, p = 0.019). HOMA-IR and FAI scores improved after metformin + IPL treatment (p < 0.05). Conclusion: Adding metformin to IPL in women with PCOS results in a significant improvement in insulin sensitivity and hirsutism.

Hand Rejuvenation Using Intense Pulsed Light

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. To assess the effectiveness of an IPL device for the improvement of dyspigmentation and overall skin quality on the dorsa of the hands. 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. 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. IPL is an effective and safe treatment option to improve solar lentigines and skin texture for hand rejuvenation.

Intense Pulsed Light Treatment of Persistent Facial Hypermelanosis Following Drug-Induced Toxic Epidermal Necrolysis

Cutaneous hyperpigmentation is one of the most cosmetically disturbing sequel of drug-induced toxic epidermal necrolysis. Intense pulsed light is a promising tool for treating some melanocytic lesions. The objective was to assess the effect of intense pulsed light in treating post-toxic epidermal necrolysis facial hypermelanosis. Two Caucasian men aged 35 and 50 years presented with long-standing (32 and 39 years) severe hypermelanosis of the face after sulfonamide-induced toxic epidermal necrolysis. They were treated by intense pulsed light. Cutoff filters of 550, 590, and 615 nm were employed for five intense pulsed light sessions at 4-week intervals. The treatment was characterized by energy fluence of 25 to 32 J/cm2, pulse width of 2.2 to 3.2 ms, and double- to triple-pulse mode respecting a 30-ms delay. Before intense pulsed light treatment, and 2 months after the fifth intense pulsed light session, clinical photographs and skin biopsies were performed in combination with quantitative narrow-band remittance spectrophotometry of melanin pigmentation. Patients were clinically followed-up for 8 months after the end of the treatment. In both patients, clinical, histologic, and spectrophotometric assessments showed an average of 80% decrease in the hypermelanosis. No clinical recurrence of the hypermelanosis developed during the 8-month follow-up after intense pulsed light treatment. No major persistent side effects were experienced, especially hypopigmentation. Intense pulsed light appears to be effective and safe for treating post-toxic epidermal necrolysis hypermelanosis in Caucasian patients.

Paradoxical effect after IPL photoepilation.

Intense pulsed light (IPL) is an effective and safe hair removal method. However, it is not exempt from side effects. To evaluate clinical and hormonal characteristics of females with facial hirsutism that developed hair growth in untreated areas close to the area submitted to IPL photoepilation ("paradoxical effect"). A total of 49 females with facial hirsutism were included in a protocol of photoepilation with an IPL source. Hyperandrogenism of tumoral origin was excluded in all subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone (OHP), and sex hormone binding globulin (SHBG) were determined prior to IPL treatment. Clinical and photographic evaluation was performed immediately before each treatment session and 2, 6, and 9 months after the last treatment session. Only cases with "paradoxical effect" were included in this study. A total of five patients with "paradoxical effect" were identified. The patients' ranged in age from 13 to 44 years and all of them had skin phototype III (Fitzpatrick scale). All these subjects were diagnosed with polycystic ovarian syndrome and presented ovarian hyperandrogenism. Patients underwent six to nine IPL sessions, and "paradoxical effect" appeared at different times during the protocol, between treatment session 3 and 6 months after the conclusion of treatment. IPL may induce activation of dormant hair follicles in untreated areas close to hirsute-treated areas.