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IPL for Port-Wine Stains

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Book cover Aesthetic Applications of Intense Pulsed Light

Abstract

Vascular anomalies can be classified as tumors (characterized by proliferating endothelium) and malformations (normal endothelial turnover). Port-wine stain (PWS) is the most common vascular malformation of the skin, present in 0.3–0.5% of newborns. Seventy to 80% of PWS occur in the face and neck regions, initially appearing as flat, pink-red macules that may gradually thicken and darken with time and may be associated with soft tissue or bone overgrowth.

In the last decades lasers have gained popularity in the treatment of PWS. Though the popular pulse-dye laser has shown benefits in the treatment of superficial PWS, it is not as effective in treating deeper PWS. There are some reasons why PWS may be resistant to treatment: inadequate depth of light penetration, inadequate conduction of heating from the chromophore to the vessel wall, inadequate blood volume (small diameter capillaries do not have enough hemoglobin) and inadequate fluence entering the capillary. Unlike lasers, owing to its variability of pulse and fluence and to its option to divide energy into different pulses, IPL enables additional heating and the coagulation of blood vessels of different diameter and different depth. Moreover, it differs from lasers by its wide spectrum of wavelengths, that leads to different absorption by the skin and a more complex tissue response. IPL respects the principle of selective photothermolysis; the preferential absorption of light by oxy/deoxy-hemoglobin and its conversion into thermal energy, leading to selective coagulation of blood vessels. Various filters can be used (available from 500 nm to 755 nm), that filter out light below the indicated wavelength. In addition, a wide range of other treatment parameters, including pulse duration, fluence, multipulse mode and intrapulse time delay, can be customized and further adjusted from treatment to treatment. The immediate appearance of perilesional erythema, a bluish-purple coloring, blanching or transient purpura is a sign of a good clinical response to the treatment. The usual treatment interval is 4–6 weeks.

We prefer starting treatment early in childhood when they are smaller and more superficially located. The child may be also referred to a pediatric consultation to rule out possible associated abnormalities. Before the treatment parents should be provided with a thorough explanation and matching of expectations should be achieved.

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Author information

Authors and Affiliations

  1. Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel

    Ori Samuel Duek & Yehuda Ullmann

  2. Plastic Surgery “Technion” Faculty of Medicine, Haifa, Israel

    Yehuda Ullmann

Authors
  1. Ori Samuel Duek
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  2. Yehuda Ullmann
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Editor information

Editors and Affiliations

  1. Emergency District Hospital, Cluj Napoca, Romania

    Lucian Fodor

  2. Director Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel

    Yehuda Ullmann

Multiple Choice Questions

Multiple Choice Questions

13.1.1 Q1: Which One of the Following Statements Is Correct Regarding Vascular Anomalies?

  1. (a)

    Vascular tumors are benign vascular anomalies that may grow over time.

  2. (b)

    Vascular malformations are a result of faulty embryonic morphogenesis.

  3. (c)

    Locally aggressive vascular tumors may result from aberrant nerve supply.

  4. (d)

    Combined vascular malformations are simple malformations that are associated with other anomalies.

13.1.2 Q2: Which One of the Following Statements Regarding Port-Wine Stains (PWS) Is Correct?

  1. (a)

    PWS occurs in 3–5% of newborns.

  2. (b)

    The limbs are the most common anatomic location.

  3. (c)

    They comprise of normal numbers of capillaries with normal endothelium.

  4. (d)

    They are more commonly observed in males.

13.1.3 Q3: For Each of the Following Wavelengths, Select the Corresponding Laser Type:

  1. (A)

    532 nm

  2. (B)

    585 nm

  3. (C)

    1064 nm

  4. (D)

    390–1200 nm

    1. (a)

      PDL (Pulsed dye laser)

    2. (b)

      KTP (Potassium-Titanyl-Phosphate laser)

    3. (c)

      IPL (Intense pulsed light)

    4. (d)

      Nd:YAG (neodymium-doped yttrium aluminum garnet laser)

13.1.4 Q4: For Each of the Following Wavelengths, Select the Corresponding Chromophore:

  1. (A)

    Absorption peaks at 980, 1480, 2940 and 10,600 nm

  2. (B)

    Absorption peaks at 418, 542 and 577 nm

  3. (C)

    Absorption spectrum 600–750 nm

  4. (D)

    Absorption spectrum 610–870 nm

    1. (a)

      Melanin

    2. (b)

      Water

    3. (c)

      Oxyhemoglobin

    4. (d)

      Deoxyhemoglobin

13.1.5 Q5: Which of the Following Lesions Was Not Found to Be More Resistant to IPL Treatment?

  1. (a)

    PWS in lower limbs.

  2. (b)

    PWS in the central part of the face.

  3. (c)

    Deep lesions.

  4. (d)

    None of the above.

13.1.6 Q6: Which One of the Following Statements May Not Explain IPL Treatment Failure of PWS?

  1. (a)

    Inadequate penetration depth of light energy.

  2. (b)

    Inadequate conduction of light-induced heating.

  3. (c)

    Inadequate epidermal cooling.

  4. (d)

    Inadequate blood volume.

13.1.7 Q7: Which One of the Following Carry a Higher Risk for Complications When Using IPL for the Treatment of PWS?

  1. (a)

    Red PWS lesions.

  2. (b)

    Lesions in Dark skin patients.

  3. (c)

    Lesion located in the face.

  4. (d)

    Lesion of small diameter.

13.1.8 Q8: Which Is the Most Suitable IPL Parameter for a Deep, Purple, PWS Lesion?

  1. (a)

    Single pulses.

  2. (b)

    Short Interpulse delays.

  3. (c)

    Short pulse duration (<10 ms).

  4. (d)

    Epidermal cooling is not needed.

13.1.9 Q9: Which Is the Most Suitable Technique When Using IPL for a Shallow PWS Lesion?

  1. (a)

    Inject local anesthetics with adrenaline before the treatment.

  2. (b)

    Press the hand piece firmly against the skin to enable appropriate contact.

  3. (c)

    Use intense epidermal cooling during the procedure.

  4. (d)

    Apply transparent gel on the lesion before passing with the hand piece.

13.1.10 Q10: Which One of the Following Statements Regarding the Post-procedure Is Not Correct?

  1. (a)

    The immediate appearance of a purple coloring of the PWS is a sign of a good clinical response.

  2. (b)

    The usual treatment interval is 2 weeks.

  3. (c)

    Avoiding sun exposure between treatments is important

  4. (d)

    There is no restriction to using make-up immediately after treatment.

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Duek, O.S., Ullmann, Y. (2020). IPL for Port-Wine Stains. In: Fodor, L., Ullmann, Y. (eds) Aesthetic Applications of Intense Pulsed Light. Springer, Cham. https://doi.org/10.1007/978-3-030-22829-3_13

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  • DOI: https://doi.org/10.1007/978-3-030-22829-3_13

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  • Online ISBN: 978-3-030-22829-3

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