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Photofacials, also sometimes referred to as IPL therapy, are among the most popular options for non-invasive, treatments.
IPL stands for Intense Pulsed Light, a technology that uses short pulses of broad-spectrum laser light directed over the skin’s surface.
Intense pulsed light (IPL) is a device that emits high-intensity, polychromatic, non-coherent and uncollimated light, whose beams have wavelengths ranging from 400nm to 1,200nm, and pulse duration of 2ms to 200ms.
The mechanism of action of IPL is based on the capture of energy by certain target tissues – the chromophores – through the principle of selective photothermolysis.
The three main human skin chromophores are hemoglobin, melanin, and water;each of which has a specific light absorption peak. Thus, the versatility of IPL allows the combination of parameters, aiming at treating the several vascular and melanocytic skin lesions, as well as perform epilation and photorejuvenation treatments, with a high skin coverage rate due to the large size of the spot.2 This is a useful alternative when patients are not willing to tolerate the adverse effects of other procedures that require longer recovery time.
Thanks to the versatility of the IPL systems, they can act on different chromophores and so are able to treat pigmented lesions, vascular lesions, acne, and rosacea. Moreover, they can also be used in photoepilation, photorejuvenation (alone or in combination with other procedures to attain better outcomes), or as a light source for PDT in the treatment of actinic keratoses, basal cell carcinomas, and acne, among other conditions.
How Does IPL Work?
A handheld device is passed over your skin, sending pulses of broad spectrum light into the deep layers of the skin. Because this pulsing light reaches the skin on a molecular level, there are no incisions or injections.
The range of light waves in an IPL treatment target melanin and hemoglobin in the skin, releasing these hyperpigmentation spots, blemishes and blotches. IPL light waves also gently heat the deeper layers of skin.
This stimulates collagen production, which reduces the appearance of fine lines, scars and wrinkles.
Unlike lasers, IPL produces more than one wavelength of pulsating light. As a result,
IPL can treat a range of skin conditions at the same time.
The target is melanosome, whose chromophore is melanin. This absorbs the appropriate wavelength, transforming the light into heat energy, which induces epidermolysis down to the basement membrane and rapid keratinocyte differentiation. These processes are accompanied by transfer of melanosomes towards the upper layers, where they are eliminated along with necrotic keratinocytes
IPL treatments can be used on the face, neck, chest, as well as arms and hands.
The immediate result of initial IPL therapy is a decrease in skin discoloration. Maintenance treatments help to keep your skin looking younger and healthy, promote collagen growth, prevent the effects of sun damage, and give the skin a healthy glow.
Another benefit of IPL therapy is that it can be used in combination with other facial skin procedures, such as chemical peels and microdermabrasion. These treatments target the surface layer of skin, while IPL reaches the deeper layers of skin.
IPL was among the first photo-rejuvenation technologies.
Today IPL is used to treat:
Rosacea (redness and visible blood vessels in the face)
Enlarged pores (IPL can help eliminate large pores and reduce the appearance of skin acne without the need for topical products that dry out skin)
Acne and acne scars
Broken capillaries (also known as spider veins due to the web-like appearance)
Dyschromia (discoloration of the skin or nails)
Melasma (brown or gray patches, usually appearing on the face)
Hyperpigmentation (darker skin patches caused by an excess of melanin, the brown pigment that produces normal skin color)
Vascular and pigmented lesions
Uneven skin tone and texture
Fine lines and wrinkles
Nonablative Skin Photorejuvenation
Thermal damage to the dermis induces fibroblast activation, with the resulting formation of neocollagen.
Neocollagenosis induced by intense pulsed light. The thermal damage to the dermis induces fibroblast activation (1), with the resulting formation of neocollagen, along with elimination of telangiectasias and pigmented lesions.
The synthesis and reorganization of type 1 and 3 collagen fibers are increased while elastic fibers, although present in lower quantity, are more neatly arranged.10 The wavelengths that best achieve these effects lie in the range of 515 to 1200nm. The longer wavelengths are absorbed by water in the dermis, triggering a cytokine-mediated reaction that stimulates neocollagen synthesis. The shorter wavelengths are absorbed by melanin and oxyhemoglobin present in pigmentation disorders and telangiectasias associated with the ageing process. Therefore, all the visible elements of ageing (fine wrinkles, laxity, telangiectasias, irregular pigmentation) are improved with a lower rate of adverse effects and a faster recovery.
Intense pulsed light has proven effective in photorejuvenation, acting not only on the vascular and pigmentary components, but also influencing neocollagenesis, improving the cutaneous texture. The principle of the use of IPL for this purpose is based on the theory that heating dermal collagen fibers with high intensity energy would cause their contraction, reducing skin looseness. In addition, heat stimulates fibroblasts that synthesize extracellular matrix proteins.
The final pathway of this stimulus is the production of collagen type I and type III, and elastin. Intense pulse light can be used for rejuvenation in extra facial areas, such as the hands. Longer IPL wavelengths – above 515nm – have more affinity with water and for this reason can activate the dermis more effectively for the stimulation of collagen. On the other hand, shorter wavelengths have a greater affinity for melanin and hemoglobin, which allows improving the dyschromias and telangiectasias resulting from the aging process. Thus, it can be seen that IPL can act on the various elements of aging with minimal adverse effects. In IPL-based extrafacial rejuvenation, some of the recommendations aimed at achieving positive results and avoiding complications are: to consider risks, weigh parameters, opt for a less aggressive treatment and a greater number of sessions. The fluence in extrafacial treatments should be 10% lower than that used in the face. With IPL, therefore, it is possible to treat all the visible elements of aging (fine wrinkles, sagging, telangiectasia, irregular pigmentation) with a low rate of adverse effects and rapid recovery.
Several articles have been published on the use of IPL in the treatment of mild-moderate inflammatory acne, although in most of these IPL was not used as monotherapy but rather in combination with another therapy or as a light source for photodynamic therapy (PDT).
Three mechanisms of action appear to be acting during treatment with IPL
Photodynamic effect. Propionibacterium acnes produces porphyrins (especially protoporphyrin ix). These substances act as chromophores with absorption peaks at 415 to 655nm. These wavelengths are absorbed by porphyrins, releasing free radicals with bactericidal effects. In addition, antiinflammatory cytokines, such as growth transforming factor beta , are stimulated.
Treatment induces selective photodermolysis of the blood vessels that feed the sebaceous glands (with oxyhemoglobin as the chromophore), leading to decreased gland size and reduced rate of sebum excretion.
A third mechanism requires an exogenous photosensitizing agent that is topically applied. This is the basis of PDT.
Mechanism of action of intense pulsed light in the treatment of acne.
Porphyrins produced by Propionibacterium acnes act as chromophores , and release bactericidal free radicals and stimulate antiinflammatory cytokine release (TGF- β) along with photothermolysis of the vessels that supply the sebaceous glands . Inflammation is eliminated and the glands are reduced.
IPL can cover the absorption peaks of both bacterial porphyrins and hemoglobin.
Pulsed dye laser (PDL) is considered the gold standard for the treatment of vascular lesions. However, this technique is limited by the need to achieve immediate purpura that lasts 10 to 14 days.
IPL systems are an alternative given the absence of purpura, reducing the down time.
Instead of inducing purpura by destruction of erythrocytes and bursting of the vascular wall, the aim of IPL is to reach a sufficiently high temperature to cause coagulation in the vessel, with the resulting destruction and fibrosis.
Mechanism of action of intense pulsed light in vascular lesions.
Hemoglobin captures energy, leading to coagulation in the vessel, which is subsequently destroyed.
IPL acts on 3 target chromophores: oxyhemoglobin (predominant in lesions of red appearance), deoxyhemoglobin (predominant in blue lesions), and metahemoglobin, with peaks of absorption at 418, 542, and 577nm, respectively. Although the peak of maximum absorption for oxyhemoglobin is at 418nm, less penetration is achieved and, in addition, there is strong competition from melanin, whereas at 577nm, although absorption is less, the degree of penetration is greater, thereby reducing absorption by melanin and avoiding side effects, such as hypopigmentation.
Current devices use longer wavelengths (515 to 600nm) to ensure deeper penetration while still being absorbed by oxyhemoglobin.
Successful treatment depends on the type and size of the vessels.
It is a chronic condition, with periods of exacerbation and remission, being prompted by a great number of triggers. Therapeutic options include topical and systemic treatments, and the use of lasers and other light sources, such as IPL. One of the advantages of IPL is that it allows that the parameters be flexibilized, meaning that it is possible to act in superficial or deep vessels according to the chosen parameters and, in addition, to focus on the caliber of the vessels that will be treated. Intense pulsed light is the treatment of choice for the erythematous-telangiectasic stage, for it acts on the vascular hyperreactivity to which rosacea is related. The treatment allows reduction of the blood flow, superficial telangiectasias and erythema intensity.
Response to IPL is effective, and because of rosacea’s chronicity, maintenance is suggested. The condition’s adverse effects profiles, which are usually subtle, also favors IPL based treatment.
The combination of IPL with the topical and systemic treatments available is interesting for it allows the synergism of the therapeutic effects, optimizing outcomes.
IPL has been shown to be an effective treatment for telangiectasias and, to a lesser extent, background erythema and papular lesions in patients with erythematotelangiectatic rosacea.
IPL systems can be a useful additional tool for the treatment of granulomatous rosacea as the reduction in the vascular component enables a decrease in dermal inflammation.
Keratosis Pilaris Atrophicans Faciei
Keratosis pilaris atrophicans faciei is a variant of keratosis pilaris characterized by erythema and follicular hyperkeratosis that can progress to atrophy. It usually has a large psychological impact and treatment is unsatisfactory. Rodríguez-Lojo et al.120 treated 4 patients, all of whom achieved an improvement in both erythema and roughness, without any side effects. The etiopathogenesis of the condition is thought to involve keratinocyte abnormalities caused by proinflammatory cytokines that lead to perifollicular inflammation followed by fibrosis and atrophy.
Pigmented Actinic Lichen Planus
Pigmented actinic lichen planus appears to correspond to the final phase of actinic lichen planus. Histology reveals abundant melanophages and incontinentia pigmenti of the papillary dermis (similar to postinflammatory hyperpigmentation). IPL has been used successfully in other hyperpigmentation disorders, such as poikiloderma of Civatte; therefore, it can also be considered a therapeutic option for this condition.
Thanks to the phenomenon of neocollagenesis after fibroblast activation, IPL was successfully used in the treatment of striae distensae.
PDT with IPL has been successfully used in the treatment of acne and could be an alternative therapy or adjuvant therapy for hidradenitis suppurativa, as the 2 diseases have a similar etiopathogenesis. Antiinflammatory-antibacterial effect and selective vascular photothermolysis.
The longer wavelengths of the IPL spectrum (close to 1,200nm), have affinity with water, stimulating dermal neocollagenesis. Meanwhile, wavelengths ranging from 400nm to 600nm, heat dermal collagen fibers and promote their contraction, leading to an improvement in the texture of the scars. Finally, the IPL’s effect on the inhibition of vasculature yields a reduction in the lesion’s thickness and elevation, inhibiting its growth.
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