Unconventional Use of Intense Pulsed Light

Abstract

According to the literature, intense pulsed light (IPL) represents a versatile tool in the treatment of some dermatological conditions (i.e., pigmentation disorders, hair removal, and acne), due to its wide range of wavelengths. The authors herein report on 58 unconventional but effective uses of IPL in several cutaneous diseases, such as rosacea (10 cases), port-wine stain (PWS) (10 cases), disseminated porokeratosis (10 cases), pilonidal cyst (3 cases), seborrheic keratosis (10 cases), hypertrophic scar (5 cases) and keloid scar (5 cases), Becker's nevus (2 cases), hidradenitis suppurativa (2 cases), and sarcoidosis (1 case). Our results should suggest that IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side effects, even though it should be underlined that the use and the effectiveness of IPL are strongly related to the operator's experience (acquired by attempting at least one specific course on the use of IPL and one-year experience in a specialized centre). Moreover, the daily use of these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving IPL effectiveness.

Full text

Clinical Study
Unconventional Use of Intense Pulsed Light
D. Piccolo,1,2 D. Di Marcantonio,3G. Crisman,4G. Cannarozzo,2M. Sannino,2
A. Chiricozzi,3,5 and S. Chimenti3
1DepartmentofDermatology,UniversityofL’Aquila,ViaVetoio,Coppito2,67100L’Aquila,Italy
2Italian Society of Laser Dermatology (SILD), Via Nicol`
o dall’Arca 7, 70121 Bari, Italy
3Department of Dermatology, University of Rome, Tor Vergata, Italy
4Department of Dermatology, University of Bologna, Italy
5Laboratory for Inve st ig at iv e Der matolo gy, e Rocke fe ll er Univers it y, Ne w York C it y, USA
Correspondence should be addressed to D. Piccolo; domenico.piccolo@univaq.it
Received  February ; Revised  June ; Accepted  June ; Published  September 
Academic Editor: Silvia Moretti
Copyright ©  D. Piccolo et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
According to the literature, intense pulsed light (IPL) represents a versatile tool in the treatment of some dermatological conditions
(i.e., pigmentation disorders, hair removal, and acne), due to its wide range of wavelengths. e authors herein report on 
unconventional but eective uses of IPL in several cutaneous diseases, such as rosacea ( cases), port-wine stain (PWS) ( cases),
disseminated porokeratosis ( cases), pilonidal cyst ( cases), seborrheic keratosis ( cases), hypertrophic scar ( cases) and keloid
scar ( cases), Becker’s nevus ( cases), hidradenitis suppurativa ( cases), and sarcoidosis ( case). Our results should suggest that
IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side eects, even though
it should be underlined that the use and the eectiveness of IPL are strongly related to the operator’s experience (acquired by
attempting at least one specic course on the use of IPL and one-year experience in a specialized centre). Moreover, the daily use of
these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving
IPL eectiveness.
1. Introduction
Firstintroducedins,intensepulsedlight(IPL)was
obtained by U.S. Food and Drug Administration (FDA)
authorization in  for the treatment of lower-limb telang-
iectasias.
is polychromatic, noncoherent, and broad-spectrum
pulsed light source (xenon lamp) is able to emit light of
a wavelength between  nm and  nm []. Its basic
principle consists in the absorption of photons by exoge-
nous or endogenous chromophores within the skin; this
transfer of energy to the target structures generates heat
and subsequent destruction of the target through a process
called selective photothermolysis. e wavelength should be
selected in dependence of the absorption peak of the target
chromophore and the pulse duration should last less than the
thermal relaxation time. is limits the diusion of heat and
damage to surrounding structures.
e main chromophores of the skin, such as haemo-
globin, melanin, and water, have a broad absorption spec-
trum. rough the use of a lter, available from  nm to
 nm, it is possible to select the wavelengths suitable for
the established treatment. e IPL’s pulse duration may be set
within a relatively wide range between  and  milliseconds,
depending on the selected device. In addition, a wide range
of treatment parameters, including pulse sequence and pulse
delay time, can be customized, thus giving users greater
versatility and accuracy [].
Versatility represents a signicant advantage for expe-
rienced dermatologists, but it could be a serious limit for
nonexperienced physicians and for nonmedical sta since
an erroneous selection of the setting can cause serious side
eects.
In daily practice, the application of a gel is necessary, as
well as direct contact between the handpiece and the skin,
although this hinders the local immediate response.
Hindawi Publishing Corporation
BioMed Research International
Volume 2014, Article ID 618206, 10 pages
http://dx.doi.org/10.1155/2014/618206

BioMed Research International
T : Clinical data.
Number of patients Gender Mean age (range)
Rosacea   M,  F . (–)
Port wine stain   M,  F . (–)
Disseminated Porokeratosis   M,  F . (–)
Pilonidal cyst   M . (–)
Seborrheic keratosis   M,  F . (–)
Hypertrophic scar/keloids /  M,  F/ M,  F . (–)/. (–)
Becker’s nevus   M  (–)
Hidradenitis suppurativa   M,  F  (–)
Sarcoidosis   F 
Total 58 32M, 26F 42.7 (8–83)
e combination of wavelength, pulse duration, delay,
anduenceallowstheuseofIPLdevicesinthetreatment
of several dermatological conditions, such as acne vulgaris,
pigmentation disorders, vascular lesions, hirsutism, photo-
damaged skin, scars and birthmarks, and melasma [–].
e authors herein suggest many unconventional uses of
IPL in the treatment of dierent dermatological conditions,
such as rosacea ( cases), port-wine stain (PWS) ( cases),
disseminated porokeratosis ( cases), pilonidal cyst ( cases),
seborrheic keratosis ( cases), hypertrophic scar ( cases)
and keloid scar ( cases), Becker’s nevus ( cases), hidradeni-
tis suppurativa ( cases), and sarcoidosis ( case).
Acne rosacea or rosacea is a chronic dermatitis of
unknown aetiology, characterized by erythema, telangiec-
tasias, papules and pustules [,].
Port-wine stain is a common congenital vascular malfor-
mation occurring in up to % of infants [–].
Disseminated porokeratosis is a localized alteration of ker-
atinization. Clinically, one or more atrophic mainly asymp-
tomatic and sometimes mildly itching plaques surrounded by
an hyperkeratotic border (histologically dened as a cornoid
lamella) are observed due to a rapid proliferation of atypical
keratinocytes [–].
Pilonidal cyst,alsoknownaspilonidal sinus or sacrococ-
cygeal cyst (due to its frequent onset in this area), is a cyst
containing hair and skin debris [–].
Seborrheic keratosis is a benign skin lesion of the epider-
mis, mainly localized on seborrheic areas, in particular, the
faceandtrunk.emostcommonclinicalpresentationis
a lesion with warty or squamous crusted surface of variable
size, coloured yellow-brown or dark-brown with blackish
specks, with so consistency [,].
Hypertrophic scars and keloids are a serious physical and
psychological dermatological condition for patients. Despite
the several studies performed on metabolisms and treatment
of wounds and scars, the exact pathogenesis of keloids
and hypertrophic scars remains unknown and this makes
therapies even more complicated [].
Becker’s nevus is a mostly male-predominant birthmark
hyperpigmentation, presenting with a unilateral (rarely bilat-
eral), benign hypermelanotic patch usually sited on the shoul-
der, chest, or lower back. Grouped brown spots with a bizarre
border are the common presentation, with hypertrichosis in
half of the cases [,].
Hidradenitis suppurativa is a common disease, also
known as acne inversa, which leads to a chronic relapsing
suppurative inammation of regions where apocrine glands
occur, that is, axilla, inguinal folds, perineum, genitalia,
and periareolar region. Several predisposing, triggering, and
etiologic factors have been encountered (androgenic dys-
function, obesity, etc.); thus, authors agree that aetiology is
still unclear. Commonly, the follicles into which the apocrine
glands open are plugged by keratin and infections, mainly
caused by anaerobic organisms which develop the following
stasis and cause cysts that are extremely painful to palpation
[–].
Sarcoidosis is both a systemic and a dermatologic syn-
drome of unknown etiology which can aect the skin as well
thelymphnodesandviscera.elesionscanbesingleor
multiple and can range from macules to large plaques and
nodules. Cutaneous involvement is referred to in up to %
of patients with systemic sarcoidosis. Plaques, maculopapular
eruptions, subcutaneous nodules, and lupus pernio can be
observed as well as cutaneous manifestations [–].
2. Material and Methods
 consecutive patients ( males and  females, mean age
.—range –) presenting with nine dierent dermato-
logical disorders were treated with IPL as an unconventional
approach (Tabl e  ). e aim of the study was to verify the
ecacy of IPL by comparing the obtained results with results
achieved through conventional treatment options (according
to the literature) using either clinical or dermoscopic pictures
before and aer each session. Notably, dermoscopy con-
ducted before treatment conrmed its usefulness in conrm-
ing diagnosis and in highlighting specic characteristics of
each condition, such as number and calibre of blood vessels,
distribution of pigment, and presence of crusts or hairs; thus,
it also represents a valid method for outcome assessments
[]. An IPL device (Deka M.E.L.A. Srl, Calenzano, Florence,
Italy) with two dierent handpieces for  nm and  nm
lters was used and set according to the skin type and clinical
characteristics of each patient. Dermoscopic images were
made in all cases before, immediately aer and at distance
from each treatment using a special lens for dermoscopy
(DermLite Foto, GEN LLC, San Juan Capistrano, CA, USA)
connected to a digital camera (Canon PowerShot A).

BioMed Research International 
T : IPL setting for each o-label dermatological disease treated.
Filters Number of pulses Pulse duration Delay Fluence Number of sessions
Rosacea erythematotelangiectatic
component   – msec  msec – J/cmUp to 
Rosacea papulopustular component   – mse c  msec – J/cmUp to 
Port wine stain   – msec  msec – J/cmUp to 
Disseminated porokeratosis   – mse c  msec – J/cmUp to 
Pilonidal cyst    msec  msec –J/cmUp to 
Seborrheic keratosis   – mse c  msec – J/cm
Hypertrophic scar and keloid
pigmented component   – mse c  msec – J/cmUp to 
Hypertrophic scar and keloid
vascular component   – msec  msec – J/cmUp to 
Becker’s nevus
hair removal  -  msec – msec – J/cmUp to 
Becker’s nevus
pigmented component   – mse c  msec – J/cmUp to 
Hidradenitis suppurativa hair
removal  -  msec – msec – J/cmUp to 
Hidradenitis suppurativa
inammatory component   – msec  msec – J/cmUp to 
Sarcoidosis   – msec  msec – J/cmUp to 
A soothing cream, a gentle cleansing, and a photoprotec-
tion (SPF) solution were prescribed to each patient aer
each session.
In the following, the authors describe the IPL scheme
treatments and the results obtained for each dermatological
condition. Each patient has been informed that at least two
sessions up to six sessions, with intervals of approximately
– days, are needed to gain signicant results.
Rosacea. Ten patients ( females and  males) aged between
 and  years (average age . years) with Fitzpatrick
phototype II-III presented with rosacea,  with an erythema-
totelangiectatic form,  with papules and pustules, and only
one with rhinophyma.
e telangiectatic component was treated with the
 nm handpiece, while the papulopustular component was
subsequently treated with the  nm handpiece (Tab l e  ).
Port-Wine Stain. Ten patients ( males and  females) aged
between  and  years (average age . years) with Fitz-
patrick phototype II-III were treated for the presence of a
PWS. Lesions were sited on the malar part of the face (
cases), on the nose ( cases), on the glabella ( case), on the
upper lip ( case), on the forehead ( case), on the posterior
part of the neck ( case), and on the posterior upper-right
limb ( case), respectively. Tab l e  shows the IPL setting used
in these cases.
Disseminated Porokeratosis. Ten patients ( females and 
males) aged between  and  years (average age .
years) with Fitzpatrick phototypes II–IV were treated for
the presence of multiple disseminated, atrophic, and slightly
itchy plaques with a hyperkeratotic border. e lesions were
mainly located on the lower extremities (%), on the upper
extremities (%), and on the back (%). Protocol shown on
Tabl e  has been successfully applied to these patients.
Pilonidal Cyst.reepatients(males),,andyearsold
(average age . years) presented with a recurrent, inamed,
sore, and swollen cyst localized in the sacrococcygeal region.
e lesion of the oldest patient had already been surgically
treated. IPL action on hair follicles is well known and
we thus suggested the use of this device with the aim of
destroying hairs encapsulated within the cyst and hairs in the
surrounding area. e anti-inammatory properties of IPL
proved to be eective in reducing the risk of recurrence. We
decided to treat the lesion according to the protocol shown
on Tabl e  .
Seborrheic Keratosis. Ten patients ( males and  females)
aged between  and  years (average age . years) with
Fitzpatrick phototypes I–III were treated for the presence
of multiple disseminated small seborrheic keratoses sited
ontheface(%),onthechest(%),andontheback
(%).

BioMed Research International
F : Rosacea: signicant results with a signicant reduction in vessel number and size and a complete disappearance of papules have
been achieved aer  IPL sessions.
All lesions were treated at intervals of – days for a
total of  sessions per case according to the protocol shown
in Tabl e  .
Dermoscopic images were obtained for each case before
(also for diagnostic purpose), immediately aer, and at a
distance from each treatment using the same equipment
described above.
Hypertrophic Scars and Keloids. Ten patients,  presenting
with hypertrophic scars ( males and  females aged between
 and  years, average age . years) and  presenting
with keloids ( females and  males aged between  and 
years, average age . years), were treated with both  nm
(vascular component) and  nm (pigmented component)
wavelength handpieces. e rst sessions with the  nm
handpiece were carried out for the pigmented component
where present. Whereupon, successive treatments with the
 nm handpiece have been made for treating the vascular
component (Table ).
At least  days of rest are required before the subsequent
session and a few months are needed to obtain very positive
results.
Becker’s Nevus. A -year-old man presented with Becker’s
nevus sited on his le shoulder blade. Clinically, a hypertri-
chotic brown patch with irregular edges of  cm ×cm in
size was observed. Successively, a -year-old man presented
with Becker’s nevus without hypertrichosis of , cm ×cm
in size and sited on his upper-right chest. In the rst case, we
decided to rst use a nm wavelength handpiece with the
aim of removing the hair components (Tabl e  ).
Aer four sessions of IPL at intervals of  days, we
performed two additional sessions with the aim of treating
the hyperpigmented component (Table ). Only the protocol
shown in Tabl e  was applied to the second patient since the
hypertrichotic component was not present.
Hidradenitis Suppurativa.One-year-oldman,previously
treated in a surgical way (clinical stage II (Hurley’s stag-
ing system) and sartorius score of ), and one -year-
old woman presented with hidradenitis suppurativa of the
axillary region, bilateral (clinical stage I (Hurley’s staging
system) and sartorius score of ).
Aer four sessions of IPL at intervals of – days,
we performed two additional sessions with  pulses of  ms
and  ms separated by a delay of  ms and a uence of
J/cm
2with the aim of treating the inammatory component
(Tabl e  ).
Sarcoidosis. A -year-old female presented with three
painful, rm, and vascularized nodules sited on the anterior
and posterior parts of the pinna and on the helix. rough
histopathological examination, a diagnosis of sarcoidosis was
posed. e patient had already undergone intralesional cor-
ticosteroid therapy without results. us, we suggested using
the IPL device with the aim of hitting the very prominent
(especially on dermoscopic evaluation) vascular component
within the lesions.
3. Results
In this study, we obtained good outcomes for all the treated
patients, who were aected by dierent dermatological con-
ditions. Our results are summarized as follows.
Rosacea. Patients required from  to  sessions, at intervals
of approximately – days, to gain signicant results, even
though a moderate reduction in vessel number and size and a
partial disappearance of papules were observed subsequent to
thesecondsession(Figure ). A -month follow-up revealed
the complete absence of recurrences and the persistence of
theachievedoutcomesinofpatients(%)whereasthe
other  patients required a new treatment within the year for
the slight relapse of the papulopustular component.
Port-Wine Stain. e results were already visible aer the end
of the rst session. Dermoscopy performed before treatment
highlighted the number, calibre, and depth of the target
vessels. Supercial vessels were hit with greater accuracy
by IPL and dermoscopic examinations revealed a change in
vessel colour from red to blue immediately aer treatment.
In cases of high numbers of vessels, erosions and crusts can
follow treatment sessions for several days. e number of the
treatments required to gain signicant results depended on
the depth and site of the PWS.
ree out of  patients (%) obtained excellent results
(disappearance of PWS),  of  (%) obtained good results
(disappearance of almost % of treated vessels), and only
one (%) obtained a moderate result (disappearance of about
% of the lesion) (Figure ). e obtained results, conrmed

BioMed Research International 
F : Port-wine stain: aer  IPL sessions, the patient gained excellent results.
F : Disseminated porokeratosis: aer  treatments, an important reduction of the hyperkeratotic edge and a reduction in the intensity
of melanin have been observed.
by dermoscopy, were stable aer a follow-up period ranging
from  to  years.
Disseminated Porokeratosis. All treated patients showed inter-
esting results, despite the fact that the histology conrmed the
persistence of cornoid lamella. In fact, one patient who had
shown signicant improvements aer four sessions presented
at the follow-up visit with an important reduction of the
hyperkeratotic edge and a reduction in the intensity of
melanin (Figure ); a punch biopsy was performed and the
histopathologic examination revealed the persistence of a
cornoid lamella.
Pilonidal Cyst. A complete resolution was achieved by the
third session ( days aer the rst visit) in  patients treated.
(Figure ) Aer a follow-up period of  years, for the rst
patienttreated,andoneyear,fortheothertwo,norecurrence
has been observed.
Seborrheic Keratosis. Supercial and small seborrheic ker-
atoses responded well to IPL, whereas larger and/or deeper
lesions may require a CO2laser or other treatment. Der-
moscopy is useful either to conrm diagnosis or to demon-
strate a change in lesion colour from brown to grey immedi-
ately aer treatment, thus predicting a good response to the
treatment. Seborrheic keratosis was usually resolved with a
mild inammation and a complete recovery within  days
aer an average of two treatments (Figure ).
Hypertrophic Scars and Keloids. Dermoscopic images reve-
aled a signicant reduction of vascular component in the
thicker areas. Scars attened and became smaller aer three
sessions. (Figures and ) All in all, good results were
achieved, even though lengthy treatment (several months) is
needed. e obtained results were stable during the follow-
up.Inoneoutofcasesofkeloids,thelesionhasresumedits
growth phase.
Becker’s Nevus. A progressive hair removal and a reduction
of the hyperpigmented area were achieved to the good
satisfaction of both patients (Figure ).
Hidradenitis Suppurativa. At the end of the suggested scheme
protocol, hidradenitis suppurativa was completely removed
in both its inammatory and painful components; hair
removal was also achieved (Figure ).
Sarcoidosis. A signicant reduction of the vascular compo-
nent and in the consistency of the lesions was achieved, thus
leading to pain disappearance (Figure ).
4. Discussion
In this study, we report on our good results achieved with
almost all  patients aected by dierent dermatological
conditions. With the aim of providing more exhaustive
details, we will briey discuss each condition separately.

BioMed Research International
F : Pilonidal cyst: a complete resolution was achieved by the third session.
F : Hidradenitis suppurativa: complete resolution of pustular-papules progressive hair removal aer  IPL treatments, bilaterally.
Clinical stage I (Hurley’s staging) and sartorius score of .
(a)
(b)
F : Seborrheic keratosis: (a) signicant reduction of multiple seborrheic keratoses of the face aer  IPL sessions, (b) seborrheic
keratoses of the back disappeared aer  IPL sessions.

BioMed Research International 
F : Hypertrophic scar: signicant reduction of vascular component in the thicker areas before and aer  IPL treatments.
F : Keloid: scar aer three sessions of IPL. Dermoscopy performed immediately aer the rst treatment showed a variation of the color
from red-blue to red.
Rosacea. Treatment of clinical manifestation of rosacea usu-
ally involves lasers such as argon, pulsed dye, Nd:YAG, CO2,
and KTP, frequently causing burns, pain, and outcomes such
as scars and signicant hyperpigmentation due to incautious
assessment of the lasers’ photophysical parameters.
e ability to choose the duration of pulses makes IPL
a versatile tool in the treatment of rosacea. e possibility
of dierent lter settings (, , , , and  nm)
allowsawiderselectionoftherangecolourofthevascular
system. A surface of . cm2can be treated with a single shot,
in contrast to the pulse dye laser (. cm2or . cm2)and
argon ( mm2). e larger surface oers greater eciency, in
terms of reducing treatment sessions, and less discomfort for
thepatient.Becauseitisabletodividetheenergyintotwo
or three pulses with dierent delays between one pulse and
the next, IPL allows the skin to cool down with minimal side
eects [].
Since the treatment is relatively unpainful, it can be
carried out in the absence of anaesthesia. Immediate response
usually presents as a slight erythema and a purple colouring
which spontaneously resolves within – hours [].
In a pilot study conducted by Mark et al., a % reduction
of blood ow, a % reduction of telangiectasias, and a
% reduction of erythema have been observed aer ve
sessions of IPL. Taub et al. noticed a reduction of % of
erythema, a reduction of % of ushing, and an improved
skin texture [,]. A  study performed by Papageorgiou
et al. noted the eectiveness of IPL in the treatment of rosacea
disease of phase I. It showed a signicant improvement of
erythema, telangiectasias, and ushing. Severity was reduced
and persistent results at  months with minimal side eects
were obtained []. Reduction in the mechanical integrity
of connective tissue of the dermis surface, responsible for
passive dilatation of the blood vessels and thus resulting in
erythema, telangiectasia, release of inammatory mediators,
and the formation of inammatory papules and pustules,
seems to play a key role in the treatment of rosacea. Moreover,
IPL can improve rosacea through the ablation of its abnormal
vessels and through the collagen remodelling of the dermis.
Furthermore, IPL determines a signicant reduction of
inammation and in the number of active sebaceous glands,
thus blocking, with great eectiveness, the altered process of
keratinization [].
In our study, all patients achieved signicant results with
tosessionsoftreatment.
Port-Wine Stain.Laserssuchasthepulsedyelaser,Nd:YAG,
alexandrite, and the diode laser are the most used ones in the
treatment of PWS [,].
Currently, the rst-choice treatment for PWS is rep-
resented by the pulsed dye laser; unfortunately, it cannot
completely remove PWS. e energy emitted reaches only
supercial vessels, thus resulting in a decreased amount of
available light to hit the deeper ones (shadow eect). Because
of this eect, hyper- and hypopigmentation and atrophic and
hypertrophic scars may result aer treatment []. When a
PWS, especially with nodular component, is treated with an
external light source, the main goal is to reach the vessels
localized at the lower surface. IPL, thanks to its variability of
pulseanduenceandtoitspossibilitytodividetheenergy

BioMed Research International
F : Becker’s nevus: a progressive hair removal and a reduction of the hyperpigmented area were achieved to the good satisfaction of
the patient.
F : Sarcoidosis: signicant reduction of the nodules with diminution of the painful sensation aer  IPL treatments.
into dierent pulses, allows an additional heating which
leads to coagulation of blood vessels of dierent diameter
and dierent depth [,]. Raulin et al. reported a –%
resolution of pink-coloured PWS aer . treatments, of red
PWS aer about . treatments, and of purple PWS aer
an average of . sessions. In a study by Ozdemir et al.,
 patients with PWS were evaluated with results of up to
% in  patients and –% in  patients. In fact, IPL
can be considered an eective treatment option. However,
IPL systems require considerable experience and should be
conducted with the aid of a good dermoscopy in order to
determine the type of vessels to treat [].
Disseminated Porokeratosis. Potential therapies include topi-
cal -uorouracil, oral retinoids, CO2laser, pulse dye laser,
Nd:YAG, cryotherapy, dermabrasion, surgical excision, and
imiquimod, or a combination of several therapies simultane-
ously [–].
In cases of supercial actinic porokeratosis, IPL proves to
be a valid therapeutic option by determining a destruction
of the pigment without risk of scarring or other side
eects.
Pilonidal Cysts and Hidradenitis Suppurativa. According to
the literature, laser technology applied in such cases includes
CO2laser and Nd:YAG. For its photocoagulative action,
CO2laser treatment produces a precise wound with minimal
blood loss, leaving a surgical eld clean and dry, but it is able
to coagulate large vessels and requires a long recovery period
[–].
IPL may represent a valid option for such lesions. e
broad light spectrum is absorbed by the hair sha, generates
heat, and destroys the hair follicle. IPL acts on the melanin
of the hair follicle causing necrosis of the follicle within the
cyst. Similarly, it acts on the hairs of the surrounding area in
order to reduce recurrence. Moreover, IPL has proven to be
a powerful anti-inammatory treatment able to eliminate the
chronic inammation within the cyst []. In , Highton et
al. selected  patients aected by HS and treated one axilla,
groin, or inframammary area with intense pulsed light two

BioMed Research International 
times per week for  weeks using a harmony laser, whereas
the contralateral side received no treatment and was used as a
control. A signicant improvement in the mean examination
and its persistence at  months led patients to report high
levels of satisfaction. No concurrent improvement on the
untreated control side has been observed. is small study
suggests that intense pulsed light may be an eective treat-
ment for HS. Although only a few data have been reported so
far, results suggest ecacy and safety and the absence of side
eects [].
Seborrheic Keratosis. In previous studies, lasers have been
demonstrated to be eective in the treatment of seborrheic
keratosis, such as alexandrite (nm) and diode laser [].
No studies on the use of pulsed light for the treatment
of seborrheic keratosis have been published so far. anks
to its broad spectrum of action, it is possible to select the
specic wavelength to act selectively on the melanin pigment
of seborrheic keratosis. Immediately aer the treatment,
a change in colour from brown to grey is observed at
dermoscopic evaluation and this represents a sign of success
of the performed procedure []. Subsequently, keratosis
tends to disappear completely without residual erythema.
e treatment is, however, limited to supercial and small
seborrheic keratoses.
Hypertrophic Scars and Keloids.epulsedyelaserhas
been reported to produce long-term improvements in the
appearance of hypertrophic scars. A very recent pilot study
has demonstrated the eectiveness of IPL in wound heal-
ingaersutureremoval.ebasicmechanismisnotyet
fully understood but most probably an action on vascular
proliferation, essential for the growth of collagen, and on
pigmentation resulting from scar formation is involved [].
DespitethewideuseofIPLinvariousskindiseases,onlyafew
studies demonstrating its eectiveness on hypertrophic scars
have been published to date. Wavelengths around  nm
are absorbed by the water within the dermis thus triggering
a reaction that leads to cytokine stimulation of collagen
bres of types I and III and elastin. e absorption peak of
the collagen bres is found to be from nm to  nm.
e heating of the collagen bres by the IPL leads to their
contraction, with a clinically detectable improvement in the
texture. e IPL, in contrast to other treatments, is not
invasive and has very few side eects. Bellew et al. have
shownthattheIPLisaseectiveasthelongpulsedyelaser
( nm), resulting in a greater soness of the scar. Kontoe
et al. reported an improvement of more than % in the
pigmentation of hypertrophic scars, % higher than that in
the scars from asphalt, and % reduction in the size and
thickness of hypertrophic scars. is is probably due to the
inhibition of the action of the vessel caused by IPL on scar
tissue and on the subsequent proliferation of collagen [].
Becker’s Nevus. Trelles et al. compared the eectiveness of the
Erbium:YAG laser with the Nd:YAG laser in  Becker’s nevus
patients,  for each group. Up to now, there have been no
studies on the treatment of Becker’s nevus with IPL. Such
treatment is able to produce synchronized single or multiple
pulses with the possibility of varying the pulse duration.
We can then select the appropriate wavelength, taking into
account the main absorption spectrum of the pigmented
structures (between  nm and  nm) and the right pulse
duration to act eciently on the hair follicle. We can operate
on both components with excellent results. [,].
Sarcoidosis. In his systematic review on the use of pulsed
dye laser in the treatment of inammatory skin diseases
published in , Erceg A reported on ve case reports of
PDL treatment for cutaneous sarcoidosis/lupus pernio [–
]. In our experience, IPL has been proven to have a signif-
icant eect on the vascular component of granulomata. Even
though IPL could not denitely treat cutaneous sarcoidosis, a
great improvement of patients’ pain and symptoms could be
achieved.
5. Conclusions
According to the literature, the eectiveness of IPL has now
been well demonstrated. Its versatility, in contrast with many
single-laser spectrums, has led to its rapid spread in dierent
clinical scenarios, while the wide range of wavelengths allows
us to use these devices for a broader range of clinical condi-
tions. However, we would like to underline how the use and
eectivenessoftheIPLarestronglyrelatedtotheoperator’s
experience. Apart from facilitating excellent outcome, the
broad spectrum of wavelengths used and the high number
of parameters can aect the nal result and increase the
risk of side eects. e daily use of these devices will surely
increase clinical experience and provide new information,
thus enhancing long-term results and improving IPL eec-
tiveness.
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
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