Inside the Dermal Clinicians Toolbox, Part 2

Part 2- IPL


Among other treatments and modalities, Dermal Clinicians study lasers, IPL technology quite extensively. So, what is IPL?


IPL, or Intense Pulsed Light, is a non-ablative, non-invasive, non-laser, high-intensity

broadband light source. IPL first made its introduction in the 1990’s, as an alternative

to traditional laser technologies. Dissimilar to lasers, to exert its clinical effects IPL

uses polychromatic, non-coherent and non-collimated broad spectrum pulsed light at

wavelengths between 400nm and 1200nm.


How does IPL work?


In IPL systems, light pulses are generated by bursts of electrical current passing

through a xenon gas-filled chamber. The lamp output is then guided toward the far

end of the handpiece, to then subsequently discharge the energy pulse onto the

skins surface via a sapphire or quartz block. IPL light pulses have a precise duration,

intensity and spectral distribution to enable controlled and confined energy transfer

to tissues. The workings of IPL systems are founded on the basis that certain targets

for energy absorption (chromophores) are capable of absorbing energy from the

broad spectrum of light wavelength. The three main chromophores found within the

human skin are haemoglobin (oxy- and deoxy-), water and melanin. All of these have

broad spectrum absorption peaks of light energy, which enables them to be targeted

by a range of specific wavelengths of light. IPL devices use dichroic or “cut off” filters

to render the device more specific and therefore selectively target various desired

chromophores, depending on the condition being treated. IPL technologies, like

lasers, employ the principle of selective photothermolysis to achieve successful

clinical outcomes. This is where photons, or light energy, is absorbed by the targeted

chromophore. This transfer of energy to the epidermal or dermal target structures

generate heat and a thermal reaction to subsequently destruct the target, while

sparing adjacent tissues and cells. IPL devices also use cooling systems to aid in

epidermal preservation, these may be; cryogen spray, contact cooling or forced

refrigerated air.




What are the advantages of IPL?

The use of IPL has become increasingly more conventional due to its many claimed

advantages. These include:


  • Flexibility and versatility for its operators, whereby the device can be configured and manipulated to target multiple chromophores over a large skin area in a single pulse. Though, this can also be seen as a serious limitation for non-experienced clinicians due to the potential for incorrect parameter selection thereby resulting in serious side-affects for patients

  • Swift procedure for clinicians, this is owing to the larger spot size which allows for the swift treatment of large anatomical areas

  • Less complex

  • More cost-effective

  • Minimal patient downtime


What are the general clinical indications for IPL?


IPL devices are employed by many practitioners to treat numerous skin anomalies

for both aesthetic and therapeutic purposes. These include:


  • Vascular Lesions (Telangiectasia, Capillary malformation, Poikiloderma of Civatte, Venous malformations, Infantile hemangiomas, Birthmarks, Port Wine Stains (PWS), Rosacea, Erythema). The IPL light targets the haemoglobin within the blood, this then generates a thermal reaction and the transfer of heat to the vessel wall to instigate coagulation and vessel wall closure and collapse.

  • Pigmented lesions (Ephelides, Solar Lentigines, Becker’s Naevus): The IPL light targets the melanin within the lesion, this then generates a thermal reaction and thereby rapid differentiation of keratinocytes, resulting in the upward transfer of melanosomes along with necrotic keratinocytes, causing their elimination. A micro crust then forms on the skins surface which in time is sloughed off.

  • Hair removal: IPL light targets the melanin within the hair shaft, follicular epithelium and the hair matrix, this then generates a thermal reaction and thus destruction and denaturation of the hair follicle, preventing further growth.

  • Ageing: IPL light targets water within the skin, this then generates a thermal reaction and heats the collagen fibres, leading to their contracture.

  • Seborrheic Keratosis

  • Hypertrophic and Keloid scarring

  • Acne vulgaris

  • Hidradenitis suppurativa


What are the risks and complications associated with IPL? And what are the current safety regulations of IPL devices within Australia?


IPL is generally considered a safe procedure, and while common side effects such

as; pain, erythema, oedema and bruising are considered normal, the delivery of IPL

procedures can still come with varying degrees of risks and complications, such as:

  • Blistering and burns

  • Hypopigmentation (thermally induced destruction of melanocytes)

  • Post Inflammatory Hyperpigmentation (PIHP) (thermally induced stimulation of melanin from the epidermal melanocytes)

  • Eye damage

  • In severe cases, scarring

While these risks and complications are rare, the majority of the cases are due to

unqualified and untrained operators using incorrect parameter and setting selections.

Operators without the correct training and education do not have an accurate

understanding of the risks and complications involved in IPL procedures, and they

may be occupying equipment that is sub-standard or poorly maintained. What’s

more, presently within Australia, only Tasmania require licensing for the employment

and operation of IPL devices. All other states within Australia currently do not have

licensing requirements, regulation or legal frameworks pertaining to the operation of

these devices. Therefore, in order to ensure the safe and effective treatment of

aesthetic and therapeutic IPL procedures, it is crucial that consumers seek

educated, qualified, and trained Dermal Clinicians.



References


Alster, T., & Husain, Z. (2016). The role of lasers and intense pulsed light

technology in dermatology. Clinical, Cosmetic and Investigational

Dermatology, 29. https://doi.org/10.2147/ccid.s69106


Ash, C., Town, G., Whittall, R., Tooze, L., & Phillips, J. (2017). Lasers and intense

pulsed light (IPL) association with cancerous lesions. Lasers in Medical

Science, 32(8), 1927-1933. https://doi.org/10.1007/s10103-017-2310-y


Babilas, P., Schreml, S., Szeimies, R., & Landthaler, M. (2010). Intense pulsed light

(IPL): A review. Lasers in Surgery and Medicine, 42(2), 93-104. https://doi.org/10.1002/lsm.20877


DermNet NZ. (2020). Intense pulsed light therapy. DermNet NZ – All about the skin

| DermNet NZ. https://dermnetnz.org/topics/intense-pulsed-light-therapy/


Goldberg, D. J. (2012). Current trends in intense pulsed light. The Journal of Clinical

and Aesthetic Dermatology, 5(6), 45–53.


Lasers, IPL devices and LED phototherapy for cosmetic treatments and beauty

therapy. (2020). health.vic. https://www2.health.vic.gov.au/public-

health/radiation/lasers-ipl-led-phototherapy


New laser and IPL regulations proposed. (2015, November 25). Aesthetic Medical

Practitioner. https://aestheticmedicalpractitioner.com.au/news/new-laser-and-

ipl-regulations-proposed/


Paasch, U., Schwandt, A., Seeber, N., Kautz, G., Grunewald, S., & Haedersdal, M.

(2017). New lasers and light sources - old and new risks? JDDG: Journal der

Deutschen Dermatologischen Gesellschaft, 15(5), 487-

496. https://doi.org/10.1111/ddg.13238


Piccolo, D., Di Marcantonio, D., Crisman, G., Cannarozzo, G., Sannino, M.,

Chiricozzi, A., & Chimenti, S. (2014). Unconventional use of intense pulsed

light. BioMed Research International, 2014, 1-10. https://doi.org/10.1155/2014/618206


The Royal Australian College of General Practitioners. (2017). Navigating the

disparate Australian regulatory minefield of cosmetic therapy. https://www.racgp.org.au/afp/2017/september/navigating-the-

disparate-australian-regulatory-minefield-of-cosmetic-therapy/


Ullmann, Y., Elkhatib, R., & Fodor, L. (2011). The aesthetic applications of intense

pulsed light using the lumenis M-22 device. LASER THERAPY, 20(1), 23-

28. https://doi.org/10.5978/islsm.20.23

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