Side effects from intense pulsed light: Importance of skin pigmentation, fluence level and ultraviolet radiation-A randomized controlled trial

TY - JOUR

T1 - Side effects from intense pulsed light

T2 - Importance of skin pigmentation, fluence level and ultraviolet radiation-A randomized controlled trial

AU - Thaysen-Petersen, Daniel

AU - Erlendsson, Andres M

AU - Nash, J F

AU - Beerwerth, Frank

AU - Philipsen, Peter A

AU - Wulf, Hans C

AU - Paasch, Uwe

AU - Haedersdal, Merete

N1 - © 2016 Wiley Periodicals, Inc.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background and Objective: Intense pulsed light (IPL) is a mainstream treatment for hair removal. Side effects after IPL are known, but risk factors remain to be investigated. The objective of this study was to assess the contribution of skin pigmentation, fluence level, and ultraviolet radiation (UVR) on IPL-induced side effects. Methods: The study was a blinded, randomized intra-individual controlled trial including 16 healthy subjects with Fitzpatrick Skin Types (FST) II–V. Three test areas were each divided into four sites, randomized to a single IPL exposure of 22, 34, 46 J/cm2 or triple stacking of 46 J/cm2. Areas were subsequently randomized to no UVR or single solar-simulated UVR exposure of 3 Standard Erythema Dose at 30 minutes or 24 hours after IPL. Each area had a corresponding control, resulting in 15 treatment sites. Follow-up visits were scheduled up to 4 weeks after IPL. Outcome measures were: (i) blinded clinical skin reactions; (ii) objectively measured erythema and pigmentation; (iii) pain measured by visual analog scale (VAS); (iv) histology (H&E, Fontana–Masson); and (v) mRNA-expression of p53. Results: Fifteen subjects with FST II–IV completed the protocol. IPL induced a wide range of skin reactions, including erythema (87% of subjects), purpura (27%), blisters (20%), edema (13%), crusting (13%), hyper- (60%), and hypopigmentation (20%). Darker skin pigmentation and increasing IPL fluence were determinants for IPL-induced side effects (P ≤ 0.002), while a single exposure of UVR did not exacerbate side effects (P ≥ 0.180). Clinical findings were confirmed objectively by reflectance spectrometry and qualitatively by histological changes in skin architecture, inflammatory infiltration, and pigmentation. Marker of cellular DNA damage, that is, p53, did not increase after IPL (P ≥ 0.24). Conclusions: Skin pigmentation and IPL fluence are major determinants of side effects after IPL exposure, while a single exposure to three SED of UVR at 30 minutes or 24 hours after IPL, does not amplify such side effects. Lasers Surg. Med. 49:88–96, 2017.

AB - Background and Objective: Intense pulsed light (IPL) is a mainstream treatment for hair removal. Side effects after IPL are known, but risk factors remain to be investigated. The objective of this study was to assess the contribution of skin pigmentation, fluence level, and ultraviolet radiation (UVR) on IPL-induced side effects. Methods: The study was a blinded, randomized intra-individual controlled trial including 16 healthy subjects with Fitzpatrick Skin Types (FST) II–V. Three test areas were each divided into four sites, randomized to a single IPL exposure of 22, 34, 46 J/cm2 or triple stacking of 46 J/cm2. Areas were subsequently randomized to no UVR or single solar-simulated UVR exposure of 3 Standard Erythema Dose at 30 minutes or 24 hours after IPL. Each area had a corresponding control, resulting in 15 treatment sites. Follow-up visits were scheduled up to 4 weeks after IPL. Outcome measures were: (i) blinded clinical skin reactions; (ii) objectively measured erythema and pigmentation; (iii) pain measured by visual analog scale (VAS); (iv) histology (H&E, Fontana–Masson); and (v) mRNA-expression of p53. Results: Fifteen subjects with FST II–IV completed the protocol. IPL induced a wide range of skin reactions, including erythema (87% of subjects), purpura (27%), blisters (20%), edema (13%), crusting (13%), hyper- (60%), and hypopigmentation (20%). Darker skin pigmentation and increasing IPL fluence were determinants for IPL-induced side effects (P ≤ 0.002), while a single exposure of UVR did not exacerbate side effects (P ≥ 0.180). Clinical findings were confirmed objectively by reflectance spectrometry and qualitatively by histological changes in skin architecture, inflammatory infiltration, and pigmentation. Marker of cellular DNA damage, that is, p53, did not increase after IPL (P ≥ 0.24). Conclusions: Skin pigmentation and IPL fluence are major determinants of side effects after IPL exposure, while a single exposure to three SED of UVR at 30 minutes or 24 hours after IPL, does not amplify such side effects. Lasers Surg. Med. 49:88–96, 2017.

KW - Adolescent

KW - Adult

KW - Biopsy, Needle

KW - Blister/etiology

KW - Dose-Response Relationship, Radiation

KW - Edema/etiology

KW - Erythema/etiology

KW - Female

KW - Hair Removal/adverse effects

KW - Healthy Volunteers

KW - Humans

KW - Immunohistochemistry

KW - Low-Level Light Therapy/adverse effects

KW - Male

KW - Pain Measurement

KW - Prospective Studies

KW - Radiation Dosage

KW - Risk Assessment

KW - Single-Blind Method

KW - Skin Pigmentation/radiation effects

KW - Ultraviolet Rays/adverse effects

KW - Young Adult

U2 - 10.1002/lsm.22566

DO - 10.1002/lsm.22566

M3 - Journal article

C2 - 27474536

SN - 0196-8092

VL - 49

SP - 88

EP - 96

JO - Lasers in Surgery and Medicine

JF - Lasers in Surgery and Medicine

IS - 1

ER -