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Intense Pulsed Light for Skin Rejuvenation

Telangiectasias, irregular pigmentation, and skin texture improved after treatment with intense pulsed light, but some found it too painful.

Intense pulsed light (IPL) treatments have been shown to improve telangiectasias and hyperpigmentation related to photodamage, but effects on wrinkles and skin texture have not been conclusively demonstrated. In this randomized, controlled, split-face trial from Denmark, 32 patients with relatively symmetrical facial wrinkles, abnormal skin texture, telangiectasias, and irregular pigmentation received three IPL treatments, spaced 1 month apart, to a randomly chosen half of the face. Treatment was delivered with a second-generation IPL device (Ellipse Flex) using a wavelength band of 530 to 750 nm and energy fluences of 7.5 to 8.5 J/cm² given in two 2.5-ms pulses, with a 10-ms interpulse delay. The results were assessed by a blinded observer, clinically and in photographs, and by patient self-assessment at 1, 3, 6, and 9 months after treatment.

Telangiectasias were significantly improved on the treated side, at all time points, in 79% to 89% of patients on clinical evaluation and 53% to 71% of patients on photographic evaluation. Irregular hyperpigmentation was significantly improved on the treated side at all time points in 59% to 77% of patients on clinical evaluation and 61% to 86% of patients on photographic evaluation. There was no significant change in overall skin pigmentation at any time point as measured by reflectance spectroscopy. In patient self-assessments, 46% reported moderate or marked improvement in their irregular pigmentation and telangiectasias. On clinical evaluation, skin texture was found to be significantly improved in 82% of patients at 1 month, in 42% of patients at 3 months, and in 56% of patients at 9 months. Significant differences in skin texture were not evident in photographic evaluations, but 58% of patients reported mild-to-moderate improvement in skin texture. No significant improvement in wrinkles was noted. One patient developed an atrophic scar on the treated side. Three patients (9%) dropped out due to the pain of treatment.

Comment: This visible-light IPL strategy is effective for the treatment of telangiectasias, irregular pigmentation, and abnormal skin texture due to photodamage. Effective treatment of wrinkles by IPL might require longer, more deeply penetrating (near-infrared) wavelengths, possibly with the addition of radiofrequency energy. The absence of skin texture improvement in the photographs may be related to the use of a ring flash, which flattens the skin surface into a two-dimensional plane. The lack of active cooling in the studied device may have contributed to the relatively high degree of pain experienced by the patients and, possibly, the one scar that developed. The impermanence of the skin-texture improvement supports the need for maintenance IPL treatments. Enhanced, longer-lasting results might have been obtained had the patients undergone a series of five treatments, as is usual in most clinical practice.

— George J. Hruza, MD

Published in Journal Watch Dermatology September 1, 2006

Citation(s):

Hedelund L et al. Skin rejuvenation using intense pulsed light: A randomized controlled split-face trial with blinded response evaluation. Arch Dermatol 2006 Aug; 142:985-90.

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