Since it first received U.S. Food and Drug Administration (FDA) approval in 1995, intense pulsed light (IPL) has become one of the most versatile and widely used technologies in aesthetic medicine. It has been used for permanent hair reduction and to treat a variety of concerns, including redness, acne and excess pigmentation. Now that it has been joined by a number of lasers and energy-based devices, the question for providers is: Which patients and indications benefit most from IPL?
Top IPL Indications
Photorejuvenation in fair skin. “IPL is still the No. 1 treatment for global skin rejuvenation and photodamage because it covers vascular concerns, pigmentation problems and stimulates collagen production,” says Michael Gold, MD, of the Gold Skin Care Center in Nashville. “If you have a patient who has predominantly photoaged skin with some wrinkling, some red spots and some brown spots, there is no other device that will treat all those concerns simultaneously.”
Mary Lupo, MD, of the Lupo Center for Aesthetic & General Dermatology in New Orleans, agrees that “IPL is sort of a shotgun treatment in that you can address both redness and brown pigment with one device. With lasers, these would have to be treated separately. So IPL is more of a generalist than a specialist device.” But she cautions that there are limitations. “It is very important to look at the patient’s skin type,” she says. “IPL is optimal for skin types I and II. It can be used on skin type III, but the 1064nm laser is safer in darker skin types and more effective for deeper vasculature.”
While IPL is best known for its ability to improve the complexion by targeting redness and pigmentation, there is a growing body of evidence that it can stimulate collagen production and prevent fine lines and wrinkles as well.
In 2012, Stanford University published a study in the Journal of Investigative Dermatology that concluded that treatment with Sciton’s BBL (broadband light) device can change the expression of genes associated with the aging process to more closely resemble young skin. In May 2016, Dr. Gold published the outcomes of more than 2,500 long-term IPL patients in the Journal of Cosmetic and Laser Therapy. All subjects received multiple IPL treatments—the majority underwent annual treatments—for 7 to 12 years. “The results were astounding,” says Dr. Gold. “Some of these patients were 45 at the beginning and 10 years later, they looked younger than when they started.”
“Due to the heat that is generated, IPL does offer some collagen stimulation—and the manifestation of that will be some temporary pore reduction, some overall skin plumping and a reduction in fine lines,” says Dr. Lupo, who notes that although IPL can help maintain skin health and prevent signs of aging, “there is no place for IPL in the treatment of skin sagging or deep wrinkles. This requires a skin-tightening treatment—IPL is primarily a color device.”
Rosacea/vascular concerns. Thanks to its ability to target redness, IPL is widely used to treat the diffuse redness and broken vessels of rosacea. In 2014, Mitchel P. Goldman, MD, co-authored a literature review to provide evidence-based recommendations for the application of IPL. For “Application of Intense Pulsed Light in the Treatment of Dermatologic Disease: A Systemic Review,” (Dermatologic Surgery), the authors searched CENTRAL, EMBASE and MEDLINE databases—dates ranging from 1974 to 2013—for studies that examined the role of IPL in primary dermatologic diseases. They gave a moderate recommendation for IPL in the treatment of erythematotelangiectatic rosacea, noting that its efficacy is comparable to the use of the pulsed dye laser.
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