Figure 1
Fig. 1. Clearing lentigines with intense pulsed light I²PL (insert: Ellipse Flex PPT, DDD, Denmark)
About the Procedure
Figure 2-1 Figure 2-2
Fig. 2. Flash lamp emission showing on the left side two short pulses (2,5 ms each) with 10 ms interval being used for photo rejuvenation (pigment removal) and on the right side a single pulse with an increased pulse duration of 10 ms, which is normally used for vascular rejuvenation (teleangiectasia) .
Figure 3a-1 Figure 3a-2 Figure 3a-3
Fig. 3a. Patient MD01452 before (left), 1 week (middle) and 4 weeks after one I²PL treatment of lentigines with 10 ms (right hand) and 2x2.5 ms (left hand) respectively, the fluence was 8.5 J/cm² at both sides. The dirty look was equal on both sides one week after the treatment. On the left hand some lentigines were still persistent (see figure 2b).

Improving the Removal of Lentigines by Extending the Pulse Duration with an Intense Pulsed Light Source

Drosner M, Institute for laser research in dermatology, cutaris center, Munich, Germany
Olbing A, Praxisgemeinschaft Dermatologie und Kardiologie, Dres. Olbing und Bittner, Bullay, Germany

Introduction

Clearing lentigines with intense pulsed light (I²PL) is easy, effective and safe (Fig. 1). However, in most cases lentigines must be treated 2-3 times and the parameter are not suitable to erase teleangiectasia. We therefore compared the efficacy of a short double pulse (photo rejuvenation PR) with a long single pulse (vascular treatment) Fig. 2.

Results

None of the 24 patients (21f, 3m, mean age 58,3 years, 36-72 years, Tab. 1) had severe or long lasting side effects except 1 case of prolonged erythema (4 weeks) occurring at the single pulse side. In the majority of cases the pigment removal with 2x2,5ms was less efficient compared to 1x10 ms (Fig. 3 and 4): With the short double pulses (2x2.5 ms) an average pigment clearing of 75,6% (SD 23,6) was achieved compared to 81,3% (SD 23,7) using the 10 ms single pulse (p < 0,05), Fig. 5. The patients preferred the single pulse for the continuing treatment

Figure 3b-1 Figure 3b-2
Figure 3b-3 Figure 3b-4
Fig. 3b. Pat. MD01452 before (above) and after 10 ms (R) or 2x2.5 ms (L) , fluence 8.5 J/cm² (both sides)
Study Design

24 volunteers with lentigines were randomly treated half side with the PR applicator (530-750 nm) of an I²PL source (Ellipse Flex PPT, DDD, Denmark) using 2x2.5 ms on one and 10 ms on the other side. The fluence was kept equal at both sides. On each side clearing and side effects were recorded 1 month after 1 treatment.

Conclusion

Extending the pulse duration in I²PL PR up to 10 ms may increase the rate of pigment clearing in lentigines with the option to coagulate teleangiectasia in the same session.

Figure 4a-1 Figure 4a-2
Fig. 4a. Pat. MD04603 before (L) and after 2x2.5ms–8.0J/cm²
Figure 4b-1 Figure 3b-2
Figure 4b-3 Figure 4b-4
Fig. 4b. Pat. MD04603 before (L) and after 10 ms – 8.0 J/cm²

The clearing of pigment was expressed as percentage of improvement (0% - 10% - 20% - … - 80% - 90% - 100%) judged by the patients themselves comparing their before and after photographs.

Figure 6
Fig. 5. Average clearing (%) of lentigines after 1 treatment at different pulse durations
Table 1
Table 1. List of patients treated for removal of lentigines by IPLS (Ellipse Flex™, PR applicator 550 – 750 nm)
Correspondance: Prof. Dr. med. Michael Drosner, cutaris center for dermatology, phlebology and laser medicine, Candidplatz 11, D-81543 Munich, Germany Tel. +49-89-6512 6500; email: drosner@cutaris.de; www.cutaris.de