Laser and Light Treatment of Acquired and Congenital Vascular Lesions
IPL treatment of PWS
IPL devices are broadband filtered xenon flashlamps that work based on the principles of selective photothermolysis. The emission spectrum of 515–1200 nm is adjusted with the use of a series of cut-off filters, and the pulse duration ranges from approximately 0.5 to 100 msec, depending on the technology. The first commercial system, Photoderm VL (Lumenis, Yokneam, Israel) became available in 1994, and has been used to treat vascular anamolies. Another, IPL Technology (Danish Dermatologic Development [DDD] Hoersholm, Denmark) with a dual mode light filtering has also been used to treat PWS. Many other IPL system have recently been developed, and the appropriate parameters for congenital vascular lesions are being developed. The IPL has been used successfully to treat PWS (Fig. 39.7),78–80 but pulsed dye laser remains the treatment of choice.
IPL technology has also been used to treat pulsed dye laser-resistant PWS. In the study by Bjerring and associates seven of 15 patients achieved over 50% lesional lightening after four IPL treatments. Most of these patients had lesions involving the V2 dermatome (medial cheek and nose), which are relatively more difficult to lighten. Six of seven of these patients showed over 75% clearance of their PWS. A 550–950-nm filter was used with 8–30-msec pulse durations and fluences of 13–22 J/cm2 to achieve tissue purpura. The 530–750-nm filter can also be used with double 2.5-msec pulses, with a 10-msec delay and fluence of 8–10 J/cm2. Epidermal cooling was not required. Treatment resulted in immediate erythema and edema, and occasional crusting. Hypopigmentation was observed in three patients, hyperpigmentation in one patient, and epidermal atrophy in one patient.