mity of the pulse delivery. Intense pulsed light has been used
to treat melasma, telangiectasias, spider nevi, rosacea, lentigines,
postburn hyperpigmentation, erythrosis, poikiloderma of
Civatte, photoinduced skin aging and to reduce hair.2,18The IPL
activates fibroblasts, resulting in the synthesis of new collagen
with wrinkle reduction, increased skin elasticity, contraction of
larger pores, reduction of brown spots, and a decrease in telangiectasias.19 Side effects of IPL include a transient erythema
and slight edema that resolve within 12 hours, PIH, and desquamating
microcrusts for 7 to 10 days.3 The major problem
in evaluating the peer-reviewed medical literature is that each
IPL device has a unique set of parameters that makes it different
from the others. Thus, when reviewing the IPL literature,
the improvement and complication profile may not be 100%
reproducible from one IPL device to another. Our experience,
and most of the published literature, is with the Lumenis IPL
systems (Santa Clara, CA), but even within one company, the
IPL systems differ based on the model.
Intense pulsed light has multiple advantages over other lasers
for the treatment of melasma. The longer wavelengths used
with IPL allow deeper penetration for treatment of dermal melasma.
The larger spot allows for more extensive areas of the
face to be treated in a shorter time period, minimizing patient
discomfort. There is also a decrease in nonhomogeneous resolution
with a decrease in polka-dot treatment results with the
IPL that can be seen with smaller laser round-spot sizes. In addition,
there are fewer local or systemic effects because of the
pulse delays in more advanced IPL systems, so the skin can be
cooled between pulses.2 This decrease in photothermal injury
leads to less PIH in comparison with Q-switched lasers.5
The IPL has been used in combination with the Q-switched
ruby laser, with 19/25 (76%) of patients reporting good to excellent
responses.20 Side effects mainly included PIH in 12%
and linear hypopigmentation in 4%. The IPL was advantageous
because of the minimal preoperative preparation, easy application,
limited posttreatment care, and a lack of downtime.
However, multiple treatments are often needed to obtain the
desired results, and deeper-pigmented patches tend to be less
responsive. The addition of the Q-switched ruby laser allows
for deeper penetration of dermal melasma but a higher risk
of PIH. Repeated IPL treatments could decrease PIH caused by the Q-switched laser. The pulse duration of IPL is in milliseconds,
resulting in a greater thermal diffusion and a more
generalized destruction of pigment. Quality-switched lasers
are in a nanosecond range, which selectively targets melanosomes
with decreased thermal diffusion.20
Poikiloderma of Civatte is similar to melasma, as both conditions
involve hemoglobin and melanin as chromophores
targeted with treatment. Goldman and Weiss reported a 50%
to 75% clearance of telangiectasias and hyperpigmentation in
poikiloderma with an average of 2.8 IPL treatments. There was
a 5% incidence of mild pigmentary side effects. Improvement
in skin texture was an added bonus with the IPL treatments.18,21
The successful use of IPL for skin rejuvenation has been well
documented in the literature.17,22-24 Nootheti et al found a 40%
improvement in photoaging after a single IPL treatment.25
Feng et al found an 84.6% pigmentation improvement and an
81.25% telangiectasia improvement after 3 IPL treatments.26
However, JØrgensen et al27 found the long-pulsed dye laser
to be advantageous over the IPL in photodamaged skin because
of superior vessel clearance and less pain associated
with the procedure. Both the laser and IPL had similar efficacy
with pigmentation clearance.27
Repigmentation with melasma eventually recurs, likely secondary
to persistent triggering factors.5 We feel that IPL is the light
source of choice for the treatment of dermal and mixed melasma
because of its lower side effect profile and ability to target
both melanin and hemoglobin as chromophores.17,21 Targeting
the vascular component of melasma in addition to the pigmentation
may be the key to improved results.
Our melasma patients demonstrate a strong correlation of vascularity
with their melasma on the VISIA Complexion Analysis
(VISIA, Fairfield, NJ). Currently, triple-agent therapy is the firstline
treatment for melasma. The VISIA Complexion Analysis
may be an easy method to determine which patients are the
best candidates for concurrent IPL therapy.
Drs. Zaleski and Fabi have no conflict of interest to declare.
Mitchel P. Goldman MD is a stockholder and consultant to Lumenis
Ltd. and a consultant to Obagi Medical Products, Inc.
- Kim EH, Kim YC, Lee ES, Kang HY. The vascular characteristics of melasma. J Dermatol Sci. 2007;46(2):111-116.
- Campolmi P, Bonan P, Cannarozzo G, et al. Intense pulsed light in the treatment
of non-aesthetic facial and neck vascular lesions: report of 85 cases. J Eur Acad Dermatol Venereol. 2011;25(1):68-73.
- Li YH, Chen JZ, Wei HC, et al. Efficacy and safety of intense pulsed light in treatment of melasma in Chinese patients. Dermatol Surg. 2008;34(5):693-700.
- Shin JW, Lee DH, Choi SY, et al. Objective and non-invasive evaluation of photorejuvenation effect with intense pulsed light treatment in Asian skin. J Eur Acad Dermatol Venereol. 2011;25(5):516-522.