Question: I did an IPL rx on a skin type 3 to the neck and chest. Hours later she developed pink to red marks in the shape of the ipl head, no blisters or breaks in the epithelium. It has now been 4 days and the redness persists,but still no blisters or epithelial disruption. I just acquired this IPL and havenot seen this before. Does this usually result in hypo or hyperpigmentation or scarring? How should I treat it now as the pt is very anxious about having these checker boards on her chest. thanks for any suggestions

what system were you using?

I was using the Sciton BBL, 515filter, maximun 17joules at 10degrees. I think the pulse duration was 15. Thanks csc3744

I have no experience in your system but IPL is IPL. The 515nm filter may be a little too aggressive on your patient. You have to review to see if she has a history of tanning, as well as any exposure to any photosensitizing agent or oral medication. I have never encountered a case of photodermatitis after IPL but it does not hurt to ask. For the red marks, my guess is that they should subside eventually. You can try a mild steroid cream or simply using a good aloe vera gel. Invite the patient to come in to see you regularly until the problem has resolved. Always be supportive and do not hesitate to refer to one of your colleagues if thing is not coming around. Let us know how it turns out in a few weeks time.

I am a Dermatologist outside the USA,in Greece.I am using Sciton BBL almost three years.The settings for 515nm filter(17j/cm ,15msec) are too much for skin type 3.The Sciton's protocol for rejuvenation is starting from 9j/cm ,20msec.I have used up to 16j/cm-10msec but in skin type 2.Anyway try a steroid cream for a few days(3-4)and see if the result would be hypo or hyperpigmentation(it usually happens the last).Don't afraid of scaring as it hasn't happened blistering.

I have to agree with Charry. I have a few comments about your settings. Your settings are too high with the 515. You need to be at the 9-10 J/cm. I think you could even make a case for settings lower than that since you were on the neck and chest. The neck and chest don't heal and repair like the face. You will end up with what appears as hypopigmentation but it may not be "true" hypopigmentation. The areas you treated will be lighter in color, hence the "striping". You probably have epidermal separation in those areas. This will be there until you even it out with another treatment. Steroid cream is your best chance to reduce the erythema but you are probably stuck at this point. Some friendly advice: follow the protocols, take into consideration the area you are treating, the skintype you are treating and remember IPL should be performed in 3-4 treatments. This allows you to start low and not impede on that fine line between great results and complications. I would also consider using your 560nm or 590nm filters for darker skintypes, especially if you don't have a lot of experience yet. Good luck.

Thank you all so much for your comments. I have seen her back after 6 days, the redness has resolved but I think there will be some epidermal sloughing and hence some pigmentary changes. She isn't all too pleased- I am trying to hand hold and reassure her as best as I can. Fortunately, no blisters or frank epidermal separation occurred. Hope this all resolves.

We have IPL and Nd-Yag from Lumenis. They suggested that we can do the boath treatments in one treatment with 10 minutes colling between for the better results for fine wrincles. Did someone tried that combination.

Lumenis suggested that IPL setings are 10 % less agresive then you normally selected for skin tipe of patient,when you do treatment with Nd Yag, and after cooling for 10 sec parametars for Yag are double shots 7ms with 20ms in between, with 120 J/cm for the face. Did someone try?

svetlana:
I think Lumines is making a mountain out of a mole in this instance. For fine wrinkles, you can stick with 1064 Nd-YAG and mix in with 3 sessions of good chemical peel and judicious use of sun block and anti-oxidant such as Vitamin A,C,E or Revale (coffeeberry) should be sufficient and much more common sense.

pmdoc:
do you have personal experience with Nd Yag from Lumenis? What you think about the parametars double shot 7ms, 20ms delay , 7 ms.Do you see any significant aprovement on fine wrincles without chemical peels. Is it best for Crow feet or forehead lines or lines on the cheeks or nasolabial area?

Svetlana:
To be honest, it is best to simply do the "skin tightening protocol" to deal with these fine wrinkle problems. The contact protocol is:
(Based on Candela and Cynosure 1064): 10mm spot size, 40 J/cm2 (cheeks, forehead, crow's feet, neck) 50J/cm2 (other areas), 50ms pulse width, 30/20 or 40/20 post cooling. I would NEVER recommend anyone to do double pulsing unless the person is very experienced. I cannot understand why a salesrep from any company would advice this technique to anyone since this is clearly OUTSIDE of a salesrep's boundary.

pmdoc:
Thank you for fast and honest answer. The tecnique is not salesrep recomandation. It is results of experience ofthe physician who work with Lumenes Nd Yag and official Lumenis protocol for fine wrincles. We have lot of experiance treating the vascular leasons with this laser.Maybe I was not clear anought, When I said double pulse I ment that one pulse consists of two short pulses and long delay betwen the pulses on 100 J/cm 6 mm spot size wich are normal proscedure ( mild one )for wascular leasons on the face, with good resutats and no risk.
I am wondering is it posible to have results in treating fine wrinkles with Nd Yag with Lumenis parametars. In my oppinion your recomandation is more logical for heating the dermis then the short pulses high energy wich are probably better for vascular leasions.

I need advise. A patient that I did 5 IPL treatments to her face with good results then she wanted her neck & chest done. These areas had moderate to severe sun damage. Her skin is on the thin, fragile side. I treated her chest with good results; however, the last treatment was a bit aggressive and she has a few red marks after one week follow up. She still had a lot of sun damage remaining and I recommended continued treatment to lift the pigment and blend the skin. I did not take photos at this time since I was not done and I recommended more treatments to help her. I since have found out that she went to another physician and was treated with 5 Pixel(like Fraxel) treatments. She came back after 18 months and her neck and chest has a few white scars on it. She seemed to hint that she wanted lifetime maintenance for her skin. Again,I didn't take photos. Her sister works for my office. This patients folder was missing and what papers I did find stops before her last two treatments. Her sister is worried that she will lose her job. The patient stated that she didn't know what she wanted to do. I offered to help her make her look better than her skin's current state. She mentioned that she had till August if she wanted to go to her lawyer. If you have any suggestions or have had any similiar situations I would appreciate the feedback.

Get a laywer, they are setting you up for a malpractice and or wrongful termination suit. Do not do anything with out a laywer and documention.