Dr. JegasothyIntense pulsed light (IPL) technology is common, versatile and, in all likelihood, has reached its technological maturity, according to S. Manjula Jegasothy, M.D., founder of the Miami Skin Institute and clinical associate professor of dermatology at the University of Miami Miller School of Medicine.
IPL is not typically the gold-star, stand-alone technology in the dermatologist's practice, because it can be less effective than many of today's single wavelength technologies, she says.
“[IPL] is a great place to start. It doesn’t have a lot of downtime. But it’s really more of an ‘and’ rather than an ‘or,’” Dr. Jegasothy says. “If a person has more of one issue — more angiomas, more telangiectasias, more poikiloderma of Civatte — it can be less effective than many of today's single wavelength laser technologies."
Dr. KormeiliIn its simplest form, IPL can be described as bright flashlight, says Santa Monica, Calif., dermatologist and clinical instructor of dermatology at UCLA, Tanya Kormeili, M.D.
“It is not a laser, in that it is not monochromatic light,” Dr. Kormeili says. “It delivers light energy from 500 nm to 1200 nm, which is along the absorption spectrum of melanin.”
IPL is a popular option among cosmetic surgery patients, according to 2016 statistics by the American Society for Aesthetic Plastic Surgery. Photo rejuvenation with IPL ranked fourth in the top five nonsurgical procedures performed by member plastic surgeons that year, wiping microdermabrasion off the top five list, according to ASAPS.
IPLs have come a long way, evolving to become much stronger and more effective than they were when the technology first came out, according to Dr. Jegasothy.
Basically, IPLs can treat skin lesions with red and brown components, according to Dr. Jegasothy.
“The most common kinds of things we treat with it are different kinds of chronic sun damage on the face, neck, hands, chest — even the hands and arms,” Dr. Jegasothy says.
Dr. PoznerIPL also is used to treat a variety of vascular conditions, from facial telangiectasia and poikiloderma of Civatte, to superficial hemangiomas and port wine stains, as well as rosacea, acne and red scars, according to Boca Raton, Fla., plastic surgeon Jason Pozner, M.D., who co-wrote an article published last year in Clinics in Plastic Surgery about IPL. [http://www.plasticsurgery.theclinics.com/article/S0094-1298(16)30019-0/abstract]
IPL treatment for skin rejuvenation can do more than diminish or remove vascular and pigmented areas, it can also improve skin texture, fine lines and wrinkles, according to Dr. Pozner.
Some still use IPL devices to remove hair, but their use is limited to lighter-skinned patients with dark hair, Dr. Pozner says.
While IPL’s primary use is to treat brown, or sun, spots, it’s a controversial treatment for melasma, according to Dr. Kormeili.
“I, personally, think it is not a good idea to use IPL to treat melasma,” she says.
The IPL device features a flashlamp that produces non-coherent, polychromatic light. Providers can adjust the light to a variety of wavelengths, fluences and pulse durations, Dr. Pozner writes.
Like a laser, IPL light results in selective photothermolysis.
Doctors and other providers usually apply a gel to the skin as an optical and thermal coupler; then, apply the device’s light topically through a rectangular light guide or crystal. While the crystal allows providers to treat a large area, they also can use adapters for smaller areas, according to Dr. Pozner.
One of the issues with IPL use is that a lot of non-physician providers offer treatment with the device. This can lead to poor patient selection, according to Dr. Jegasothy.
“I definitely would not do IPL on anybody who is more than a skin Fitzpatrick III; maybe a light Fitzpatrick IV,” Dr. Jegasothy says.
Why? Hyperpigmentation, she says.
“The problem isn’t usually the laser or laser setting; it’s patient selection,” Dr. Jegasothy says.
Dr. Kormeili agrees that IPL is best on lighter skin types, I through III, and can cause discoloration on types IV and V.
Post-inflammatory hyperpigmentation is especially likely to occur if the skin is tanned prior to or after the treatment, according to Dr. Kormeili.
To help prevent discoloration and burning, IPL devices have a built-in cooling mechanism on the part of the tip that comes in contact with the skin, Dr. Kormeili says.
Dr. Jegasothy recommends physicians start treating patients with the IPL on a low setting — the lowest 20% or 30% that the device allows.
“Do a test area on an inconspicuous part of the skin... Then, see what the result look like a week later and a month later, if you can, so you know you’re not going to burn the patient,” Dr. Jegasothy advises.
Some believe that using a hydroquinone-based bleaching cream prior to IPL treatment is ideal, as it decreases production of melanin and reduces the chance for post-inflammatory hyperpigmentation, according to Dr. Kormeili.
“The skin should never be tanned in the two weeks before or after the treatment. It must be used with outmost caution in ethnic skin,” Dr. Kormeili says.
Dr. Jegasothy says all the available IPL devices by reputable laser companies seem to be good technologies.
“I don’t have a favorite,” she says. “"The technology has probably reached its maturity, and current models may be as good as they're going to get."
IPL is a simple technology to produce. As a result, many companies offer the devices, Dr. Kormeili says.
“I think the European, Israeli and American manufacturers produce better products than Asian brands. Having said that, the stronger and more complex the machinery, the higher the chances of complication,” Dr. Kormeili says.
Dr. Kormeili recommends that practices first decide if doctors or nurses will be performing IPL treatments before buying a specific device. If the nursing staff will be doing IPL treatments, a simpler IPL device might be a better decision to reduce the risk of complications, she says.
Practices should also look for companies that offer adequate training and are available to help with complications, if they occur.
“Additionally, if the goal is to bring the patient back many times, then a less effective, less risky laser is the best choice,” Dr. Kormeili says. “In my dermatology practice, I need to offer real results, fast and quick. Therefore, I need powerful [devices] that, obviously, if used incorrectly, can have complications.”
Disclosures: Drs. Jegasothy and Kormeili report no relevant disclosures. Dr. Pozner is a consultant/speaker for Sciton.