Efficacy and safety of intense pulsed light for the treatment of facial erythema: a systematic review and meta-analysis.

INTRODUCTION: Facial erythema can be seen in many patients. Despite various clinical trials exploring the effect of intense pulsed light (IPL) in treating facial erythema, comprehensive evidence about the specific outcomes remains lacking. EVIDENCE ACQUISITION: We searched published studies in the Web of Science, PubMed, Embase, and Cochrane Library databases based on established inclusion criteria. We calculated odds ratios (OR) to evaluate the effectiveness of IPL in patients with facial erythema. We used Review Manager 5.4.1 software for statistical data analyses with a 95% confidence interval (CI). EVIDENCE SYNTHESIS: This review includes seven studies with 219 patients, of which five compared the efficacy of IPL with pulsed dye laser (PDL). IPL significantly improved facial erythema compared to no treatment (OR=56.64, 95% CI: 22.70-141.33; P<0.00001). However, there was no significant difference between IPL and PDL treatment (OR=1.00, 95% CI: 0.31-3.22; P=1.00). Moreover, there was no significant difference in patients with a >50% reduction in telangiectasias between IPL and PDL treatment (OR=1.00, 95% CI: 0.39-2.56; P=1.00). Furthermore, IPL therapy had no apparent adverse effects for most people besides transitory edema and erythema. CONCLUSIONS: Our meta-analysis indicated that IPL could effectively and safely improve facial erythema with similar efficacy to PDL. Based on its comprehensive function, light side effects, and long curative effect, IPL appears to be a good alternative for treating facial erythema. However, further prospective and high-quality studies are required.

LONG-PULSED ND:YAG LASER TO TREAT TELANGIECTASIA OF THE NOSE: A COMPREHENSIVE 5-YEAR SINGLE CENTER STUDY.

Telangiectases of the nose are of esthetic concern and treatment is warranted. The study provides the results of 5 years of treatment of telangiectases of the nose region with the long-pulsed Nd:YAG 1,064 nm laser. A retrospective analysis was conducted in patients of Fitzpatrick skin type II-V. Exclusion criteria were patients with a previous history of treatment of the nose region, pregnant or lactating patients or patients with unrealistic expectations regarding the treatment risks, limitations and results. Standardized photographs were obtained before each session and at least 2 months after the last treatment session. A long-pulsed Nd:YAG 1,064 nm laser was used with a spot size of 2.5mm, fluence of 100 - 175 J/cm2, pulse duration of up to 135ms and repetition rate of 2-4 Hz. The follow-up ranged from 2 months to 5 years. The number of laser sessions varied from 1 to 5 monthly. Assessment was made by comparing pre-treatment and post-treatment photographs by two independent specialists and also by the patients' own assessment. All patients presented improvement of the vascular alterations. Evaluation of independent specialists as well as the evaluation of the patients themselves showed a high degree of satisfaction with the treatment. The treatment presented only few transitory side effects. Treatment of telangiectasia on the nose skin with the long-pulsed Nd:YAG 1,064 nm laser demonstrated to be safe and effective even in darker pigmented skin. The major limitation of this study is its retrospective nature.

Efficacy and Safety of Intense Pulsed Light With a KTP/PDLlike Filter for the Treatment of Facial Telangiectasias.

BACKGROUND: An intense pulsed light (IPL) narrowband "KTP/PDL-like" filter (525–585 nm) may combine the tolerability of the IPL with the precision of KTP and PDL lasers. This study evaluated the impact of IPL with a KTP/PDL-like filter on telangiectasias. METHODS: This was a single-center, prospective study of 17 subjects with facial telangiectasias and skin types I–III. Three monthly treatments were performed using this specific filter, with follow-up visits at 1, 3, and 6 months. Telangiectasia improvement was assessed by the investigator and subjects using a 5-point scale. Facial photographs and safety assessments were obtained at each visit. Subject discomfort was evaluated using a visual analog scale (VAS) immediately posttreatment, and subject downtime was recorded at each subsequent visit. RESULTS: All facial telangiectasias significantly improved. At 1-month follow-up, >50% lesion clearance was noted in 97.1% of facial (n=36) and 85.7% of non-facial (n=7) lesions, with 73% of subjects satisfied or very satisfied. An increase in mean social downtime (0, 2.3, and 3 days) and VAS scores (3.5, 4.5, and 4.8) with treatments 1, 2, and 3, respectively, mirrored a stepwise increase in fluence with subsequent sessions. CONCLUSIONS: The use of a novel IPL narrowband KTP/PDL-like filter can significantly improve facial and non-facial telangiectasias with minimal downtime. J Drugs Dermatol. 2020;19(9):844-850. doi:10.36849/JDD.2020.4834.

Frontiers in translational systemic sclerosis research: A focus on the unmet 'cutaneous' clinical needs (Viewpoint).

This viewpoint considers four cutaneous unmet clinical needs of patients with systemic sclerosis (SSc), namely the rapidly progressive skin thickening (scleroderma) which occurs early on in diffuse cutaneous disease; digital (finger and toe) ulcers; calcinosis; and cutaneous telangiectases. All four problems cause pain, disability and/or disfigurement, all impact on quality of life, and for each, we require effective treatments. For each unmet need, we give a brief description of the clinical problem (including clinical burden), pathophysiology and current treatment, followed by a personal viewpoint of the key questions which research must address. For the painful, debilitating skin thickening of early diffuse cutaneous SSc, studies are required to decide whether corticosteroids are effective and safe (current opinion is divided) and whether phototherapy approaches have a role. Also, we need to develop and validate reliable outcome measures for clinical trials of promising new therapies: these could be composite indices, novel non-invasive imaging methods and patient-reported outcome measures, possibly in combination as they provide complementary information. For digital ulcers, again we require validated outcome measures for clinical trials. We also need to explore local (including topical) treatments, which are free from systemic adverse effects, and preventative strategies for high-risk patients. For calcinosis, we need to better understand pathophysiology, to validate outcome measures and to develop topical treatments. For telangiectases, we need to "use" these highly accessible lesions to help unravel the vascular pathophysiology of SSc and explore their different properties as potential biomarkers.

Cutis marmorata telangiectatica congenita successfully treated with intense pulsed light and pulse dyed laser therapy: a case report.

Cutis marmorata telangiectatica congenita (CMTC) is a rare vascular disorder characterized by blue-purple reticulated patches and plaques that can be localized or generalized. Associated skin atrophy and soft tissue hypoplasia is common while ulceration is relatively uncommon. As CMTC is exceedingly rare and spontaneous remission in childhood can occur in mild cases, evidence for treatment of severe, refractory disease is limited. We present the case of a four-year-old female with CMTC and associated painful, recalcitrant ulcers successfully treated with a combination of pulsed dye laser and intense pulsed light therapy.

A retrospective analysis for facial telangiectasia treatment using pulsed dye laser and intense pulsed light configured with different wavelength bands.

BACKGROUND: Facial telangiectasia is one of the common skin vascular lesions characterized by dilated cutaneous vasculatures. The variety of diameters and difference in depths of lesional blood vessels are the major challenges for effective treatments for Facial telangiectasia. AIMS: To compare the efficacy and safety profiles of pulsed dye laser (PDL, 595 nm) with intense pulsed light (IPL) configured by three different wavelength bands in the treatment for facial telangiectasia in Asian populations. PATIENTS/METHODS: A retrospective analysis of hospital records and review on photographs were performed for those subjects with facial telangiectasia (n = 160) who were treated in our department from January 2017 to January 2019. Patients were received two sessions of one of the four following laser treatments: PDL (595 nm, n = 38), IPL with M22 vascular filter (530-650 nm and 900-1200 nm, n = 39), M22 560 (560-1200 nm, n = 42), and M22 590 (590-1200 nm, n = 41). RESULTS: The patients in all the four groups showed an overall and significant improvement of indexes of lesional severity and subjective discomfort as well as improvement score of facial telangiectasia after treatment as compared to baseline. In addition, PDL (595 nm) and IPL with vascular filter (530-650 nm and 900-1200 nm) treatments showed significantly better indexes of lesional severity, subjective discomfort, and improvement score of facial telangiectasia as compared with other two treatments. CONCLUSION: Light devices with various wavelength ranges showed different efficacies of treatment for facial telangiectasia, among which PDL (595 nm) and IPL with M22 vascular filter (530-650 nm and 900-1200 nm) had similar and the best clinical efficacy as compared to IPL with other wavelength bands.

New Insight in Noninvasive Rejuvenation: The Role of a Rhodamine-Intense Pulsed Light System.

Background: Rhodamine-intense pulsed light (r-IPL) is a noncoherent, noncollimated, polychromatic light energy optimized for a double-peak wavelength emission, ranging between 550-680 and 850-1200 nm. Traditional IPL works within visible and infrared spectra, targeting hemoglobin and melanin, are effective to treat rosacea and pigmentary disorders. r-IPL, a new technology in dermatology, emits high-intensity light with a wavelength peak similar to the one of the pulsed dye lasers, showing a good safety and efficacy profile in nonablative photorejuvenation. Objective: Assess efficacy and safety of r-IPL on photodamaged facial skin showing hyperpigmentation, telangiectasias, fine lines, and textural changes. Methods: Five sessions of r-IPL treatment (fluence ranged between 13.5 and 14 J/cm2) have been performed on one 75-year-old lady affected by facial photodamaged skin. Efficacy of treatment was evaluated using the Fitzpatrick Elastosis and Wrinkles Scale (FEWS) and the Global Aesthetic Improvement (GAI) Scale assessed by an investigator, compared with baseline. Treatment safety and tolerance were also evaluated using the Visual Analog Scale (VAS). Results: Photographic and multispectral evaluation demonstrated relevant improvement (vascular, pigment, and texture) of photodamaged facial skin. One month after the last treatment, significant improvement in facial wrinkle and texture was noted. FEWS scores decreased significantly from 7 to 2. According to the GAI scale, the patient had an improvement in skin texture. Immediate response included mild-to-moderate erythema and only trace-mild edema in the treatment area. Pain during the treatment was minimal with a mean VAS pain score of 3/10. No other adverse events were reported. No post-treatment downtime was recorded. Conclusions: r-IPL may represent a valid therapeutic approach in noninvasive photorejuvenation.

Open-label study assessing the efficacy and tolerability of topical skin care and sun protection alone and in combination with intense pulsed light therapy.

BACKGROUND: Intense pulsed light therapy (IPL) decreases facial erythema and telangiectasias associated with rosacea. Topical skin care products decrease facial erythema by the action of active ingredients and masking effects. OBJECTIVES: To assess the efficacy and tolerability of combining a topical skin care regimen (TSCR) comprised of a multifunctional three-in-one facial cream and a mineral-based brush-on SPF50 powder sunscreen with a single IPL treatment for treating mild-to-severe facial redness associated with rosacea. METHODS: Twenty female subjects with Fitzpatrick skin types I-III received TSCR monotherapy for 12 weeks. At that time, subjects received a single IPL treatment and continued TSCR for 6 additional weeks. Subjects were evaluated at Baseline and at Weeks 4, 8, 12, and 18. RESULTS: Using a 7-point redness scale, the overall mean (SD) redness score significantly improved from 3.05 (0.97) at baseline to 2.05 (0.76) at Week 18 (P < 0.01). There was a decrease in investigator-rated erythema from baseline (bare skin) to Week 12 (bare skin, before IPL) when TSCR was used as monotherapy which did not achieve significance (P = 0.12). Most subjects (80%) were satisfied or Very satisfied with the TSCR at Week 18. All subjects (100%) agreed that it improved their baseline skin redness and most (85%) would recommend TSCR to others. TSCR was well-tolerated with no significant changes in skin dryness, scaling, or itching. Mild burning occurred immediately following the IPL treatment at Week 12. CONCLUSION: TSCR in combination with a single IPL treatment produced a significant improvement in overall facial redness in patients with rosacea. Longer-term treatment with TSCR may produce continued improvement.

Latent Demodex infection contributes to intense pulsed light aggravated rosacea: cases serial.

Intense pulsed light (IPL) is a good option for erythema and telangiectasia of rosacea. Demodex, which is light and heat sensitive, is an important risk of Rosacea. Sometimes, IPL can induce rosacea aggravation. Here, we show two cases of erythema rosacea aggravated as pustule in several hours after IPL. Both cases show high density of Demodex after IPL. Neither of them had photosensitivity, systemic disease, or any other contraindication for IPL. One of the patients received IPL again after Demodex infection relieved and this time there was no inflammation induction. We need to attract more attention to IPL-induced rosacea aggravation and latent Demodex infection may act as a cofactor.

Intense pulsed light is effective in treating postburn hyperpigmentation and telangiectasia in Chinese patients.

Intense pulsed light (IPL) has been used to treat postinflammatory hyperpigmentation and telangiectasia in Fitzpatrick type I -II skin. However, its therapeutic effects after superficial second-degree burns in Asian populations with Fitzpatrick type III-IV skin are uncertain. Thirty-five Han Chinese patients with facial or hand hyperpigmentation and telangiectasia due to second-degree fire burns received treatment with IPL. Each patient underwent 2-6 treatments over 3-5 weeks. The laser wavelength was 560-615 nm. Skin pigmentation was evaluated by two plastic surgeons as well as by the patients themselves (self-evaluation) before treatment at the end of the treatment cycle and 1 year after the first treatment. Blood flow in telangiectasia skin was measured by laser Doppler flow. The results showed that IPL significantly lessened hyperpigmentation so that close to normal skin color was achieved after the treatment cycles, and pigmentation did not reoccur 1 year after the first treatment. Approximately 82.9% of the patients were satisfied with their treatment outcomes. There were no post-treatment complications. Doppler showed a significant decreased blood flow in telangiectasia after treatment. In conclusion, IPL is an effective and safe modality for Chinese patients with hyperpigmentation and telangiectasia after fire burns.

[Laser and light therapy for treatment of radiation dermatitis]. / Laser- und Lichttherapie zur Behandlung der Strahlendermatitis.

Radiation dermatitis (RD), an inflammatory skin disease that can be an unwanted side effect of medical radiation therapy (RT), most commonly occurs in patients undergoing cancer of the ENT, anal, and vulvar regions. The side effects on the skin and mucous membranes occur within a few weeks after the initiation of RT; however, late side effects can develop months to years after the RT. Therapeutically, various treatment approaches are considered such as pentoxifylline, hyperbaric oxygen therapy, laser therapy, and PBMT. In order to limit the reduced quality of life of patients with RT-induced fibrosis, supportive care consisting of pain therapy, psychological support, and wound care is necessary.

Cutis mormorata telangiectatica congenital successfully treated with intense pulsed light therapy: A case report.

Cutis marmorata telangiectatica congenita is a rare disorder characterized by cutis marmorata, telangiectasia with or without recurrent ulcerations. It is a benign vascular anomaly with dilatation of capillaries and veins in the dermis. There is no satisfactory treatment for the ulcerative variety of cutis marmorata telangiectatica congenita. In this case, intense pulse light therapy was used with almost near total cure. Intense pulse light with its vascular filter of wavelength 550-1200 nm was used every fortnight till complete resolution of lesions.

TRASER: An innovative device for the treatment of nasal telangiectasias.

BACKGROUND: Destruction of blood vessels by selective photothermolysis has been successfully achieved using a number of different laser and light systems, none of which provide significant independent variation in parameters such as wavelength. OBJECTIVE: To evaluate the safety and efficacy of a novel configurable device in the treatment of nasal telangiectasias. METHODS: Fifteen subjects aged 42-73 with Fitzpatrick skin types I and II were treated for nasal telangiectasias of various sizes. Efficacy was measured by blinded analysis of pre and post images and self-assessment by the subjects. The primary endpoint was a 2-point improvement of telangiectasia based on a 5-point Telangiectasia Scale comparing the pre-treatment photograph to the post-treatment photograph at 30 days post final treatment by an independent reviewer. Treatment completion was defined as >75% vessel clearance. The TRASER (Total Reflection Amplification of Spontaneous Emission Radiation) was configured to produce a narrow spectral output, peaking at 541 ± 5 nm, with 20-40 millisecond pulses over an energy density range of 15-40 J/cm2 utilizing a 12 mm spot size were delivered with contact sapphire cooling tip at approximately 10°C. RESULTS: All 13 subjects (100%) in the efficacy population achieved procedure success at the end of the final treatment, that is a 2-point improvement of telangiectasis on the telangiectasia scale (pre- vs. post-treatment). A single treatment was effective in >75% of patients with at least a 75% reduction in blood vessels. Larger vessels responded well to longer pulse durations (40 milliseconds) while smaller vessels responded best to shorter pulse durations (25 milliseconds). No serious adverse events (SAEs) were recorded. LIMITATION: Short-term (1 month) follow up. CONCLUSION: The TRASER device is a safe and effective option for treatment of nasal telangiectasias with all subjects meeting primary endpoint success at the end of treatment and the majority of subjects demonstrating clearance after only one treatment. These treatments were well tolerated and provided high patient satisfaction. Lasers Surg. Med. 49:625-631, 2017. © 2017 Wiley Periodicals, Inc.

Sequential delivery of intense pulsed light and long-pulse 1.064-nm neodymium-doped yttrium aluminum garnet laser shows better effect in the treatment of facial telangiectasias than using them separately.

BACKGROUND: Intense pulsed light (IPL) and 1.064-nm Nd:YAG laser are both being used for the treatment of vascular lesions. This study compared the treatment efficacy of combined therapy versus separately delivery of IPL or 1.064-nm Nd:YAG laser in facial telangiectasia in a split face study design. METHODS: Twenty-four patients were studied using the sequential delivery of IPL and Nd:YAG laser on one side of the face (combined therapy side). The other side received IPL treatment first followed by Nd:YAG treatment 3 days later (separated therapy side). Subjects received single session treatment and evaluated after 4-weeks follow-up. Outcome measures were clinical efficacy (7-point Telangiectasia Grading Score [TGS]), pain (10-point numerical scale), adverse effects, patient satisfaction (10-point numerical scale) and preferred treatment. RESULTS: There are higher TGS scores (4 and 5) in combined therapy sides than in separate therapy sides. The differences in blinded-ratings for both sides were statistically significant. Patients were satisfied in both treatments. However, more subjects preferred the combined therapy over separated treatment. Patients experienced less pain from separated treatment than combined treatment. There were no reports of scarring, dyspigmentation, telangiectatic matting, crusting, blistering or textural changes in any subjects. Combined therapy sides have more incidences of erythema, purpura, and edema in 48 hours post-treatment than separated therapy sides. CONCLUSIONS: The sequential delivery of IPL and Nd:YAG laser suggests that the synergistic approach for facial telangiectasia is a superior method compared to separated therapy.

Three-Dimensional Rejuvenation of the Décolletage.

BACKGROUND: Photodamaged skin of the chest is characterized by skin laxity, lines/wrinkles, hyperpigmentation, erythema, tactile roughness, atrophy, and telangiectasias. METHODS: A MEDLINE search was performed on combination treatments in chest rejuvenation, and the results are summarized. Practical applications for these combinations of procedures are discussed. RESULTS: Reports of injectable poly-L-lactic acid (PLLA), hyaluronic acid (HA), and chemical peels, along with lasers and light therapies such as intense pulsed light (IPL), vascular lasers, photodynamic therapy (PDT), nonablative fractionated lasers (NAFLs), ablative fractionated lasers (AFLs), and microfocused ultrasound (MFU) have been reported for chest rejuvenation. Few articles were discovered pertaining to combination therapy. The authors review their approaches to combination therapy. CONCLUSION: Multiple options exist alone or in combination for minimally invasive rejuvenation of the skin of the chest including PLLA, HA, chemical peels, IPL, vascular lasers, PDT, NAFL, AFL, and MFU. Little was found in the literature pertaining to the safety and efficacy of combining such procedures and devices. The authors' experience in clinical practice is that combination, same day chest rejuvenation techniques can be performed safely. A combination approach often produces the most optimal outcome for the patient seeking chest rejuvenation.

A Multimodal Approach to Rejuvenation of the Lower Face.

BACKGROUND: Facial aging is multifactorial, including changes in all the anatomical layers of the face including bone, fat, connective tissues and skin. METHODS: An evaluation of the multifactorial causation of facial aging pointed to the need for a multifactorial approach to restoration and rejuvenation of the aging human face. RESULTS: The varied aetiologies of the expressions of facial aging require more interventions than a unipolar approach. Combinations of neuromodulators, three and two-dimensional fillers and energy based devices were discussed. Surgical interventions were also discussed but were not addressed in this paper. CONCLUSIONS: A multimodal approach to lower facial rejuvenation and restoration is discussed as the most effective and appropriate method to achieve noninvasive aesthetic treatment success.

Treatment of facial telangiectasia with a small spot of intense pulsed light: a case series of three patients.

Intense pulsed light (IPL) technology has long been used in the treatment of facial telangiectasia. While the large spot size of traditional IPL devices offers rapid coverage, it has limitations in terms of visibility and uniform contact with the skin in contoured areas of the face. The novel IPL used in this study had a small spot size (6.35 mm) and shorter wavelength (500-635 nm), allowing the use of high fluence without burning the normal epidermal tissue surrounding the lesion, thus providing better efficacy. Treatment of facial telangiectasia using small-spot IPL is effective with a low risk of dermatological damage, and its uses for medical care are expected to diversify.

Consensus recommendations from the American acne & rosacea society on the management of rosacea, part 4: a status report on physical modalities and devices.

The fourth article in this 5-part series reviews physical modalities and devices used to treat cutaneous rosacea based on consensus recommendations from the American Acne & Rosacea Society (AARS) on the management of the common presentations of cutaneous rosacea. The major therapeutic uses of physical modalities and devices, especially laser and light-based systems, are for treatment of telangiectases and persistent facial erythema (background erythema). Phymas, especially rhinophyma, also are treated with physical modalities such as ablative lasers or surgical devices (eg, electrosurgical loop). Appropriately selected and properly used lasers and intense pulsed light (IPL) devices can successfully address specific clinical manifestations of rosacea that exhibit limited or no response to available medical therapies, such as telangiectases and background centrofacial erythema. Rosacea-associated symptoms also may improve. In most cases, treatment will need to be repeated intermittently to sustain improvement.