I am an Asian female who underwent IPL to treat folliculitus and ingrown hairs. On my fourth treatment I suffered superficial burns on my bikini line, but was assured that they would heal. They did, eventually, but I was left with dark pigmentation marks on the area. When they did IPL on the same area to treat it, I got burnt again.
My therapist claims to have skipped the burnt area and claims confusion over what had happened. She advised me to use lavender oil to treat it but my GP and a pharmacist prescribed other creams for burns. How should I deal with these burns? Would you know if they would cause scarring and how I can avoid them on my next treatment? Thank you.
The burns that the patient describes are the result of too much light energy going into the skin. The way IPL works is light energy is absorbed by the pigment that we want to get rid of (in this case it is melanin in the hair) and that energy is converted to heat. The heat damages or destroys the structure holding the pigment. Not enough energy, not enough heat and nothing happens. Too much energy, too much heat and you get burned.
Some people, particularly people with darker skin, like Asians, may, as this patient did, react to with local darkening of the skin at the site of the burn. This is called post inflammatory hyperpigmentation. PIH can occur without a burn but with just too much heat.
There are several things that can be done to prevent burns and subsequent PIH. The first thing to do is make sure that the amount of energy used will do the job but not hurt the skin. The operator of the device has many ways to do this, but it requires scrupulous attention to the skin and the device as well as knowledge of the skin, the physics of photobiology and the equipment used.
The second consideration is the prevention of the resultant post inflammatory hyperpigmentation. The best way to do this is to first identify which patients are most at risk. Those with darker skin (like Asians) are at the top of the list and require special care. It may be necessary to pretreat them with a melanin inhibiting agent like hydroquinone. The IPL or laser settings must be appropriately conservative.
If a burn does occur it will most likely be a second degree burn - like a curling iron burn. It should be initially treated with a topical antibiotic ointment like Neosporin. It should heal without a scar, but there may be PIH.
If there is post inflammatory hyperpigmentation it will most likely resolve on its own after a few weeks. If it does not improve or resolve it may be treated with a melanin inhibiting agent like hydroquinone or kojic acid. I believe that IPL is contraindicated in the treatment of this temporary pigment disorder because IPL is designed to cause the heat that brought on the PIH. In the presence of the PIH there is more pigment and more light energy will be absorbed, creating more heat.
To answer the patient's direct questions: treat the burns with Neosporin, treat the PIH with hydroquinone or kojic acid when the burns have healed. Tincture of time will help, also. Unless they are third degree burns (unlikely) there will be no burn scars. Avoid future burns by avoiding further IPL or at least have a much less aggressive treatment.
IPL is a good modality for several different procedures, but can occasionally cause a burn in thebest of hands. Usually brownish flaky skin develops over the site of sunpsots if used for this , and they flake off( this is how it works) For hair removal it works a bit differently ans hould not cause these spots, but can sometimes happen. HYyperpigmentation may develop in some individuals.
Anytime there is a burn on the skin from a
laser treatment it is best to keep it moist with topical ointment such as
Aquaphor, or an antibiotic ointment. Avoid the sun to that area as to not make
it more inflamed. After it has healed
you can attempt to decrease the hyperpigmentation with a topical hydroquinone
cream. As for future IPL treatments it
is best to choose a provider who is knowledgeable in the laser settings for
your skin type to avoid any complications. I would also recommend scheduling a
consultation with a board certified plastic surgeon.
Initially, you can apply aquaphor a couple of times daily to the burns and let them heal naturally without picking at any scabbing or blisters. Sun avoidance is recommended to reduce worsening of any post inflammatory hyperpigmentation. Once the area is healed, skin lightening agents may be used such as hydroquinone. There are also non hydroquinone alternatives. These topical creams have to be used daily and consistently. Your clinician can instruct you on how to use these creams. The settings can also be adjusted to reduce the chances of reactions with the treatment or you can try a different hair removal machine, such as an Nd:yag laser that may be safer for your skin type and effective for hair removal. I recommend that you consult with someone for an alternative method since it seems that you are having issues with the IPL.
It may be possible to improve the pigmentation by using lightening agents like hydroquinone bleaching cream. I recommend that you see a board certified dermatologist or a board certified plastic surgeon.
Occasionally, there can be post inflammatory pigmentation, if your skin was burnt during an IPL procedure. But it is possible to improve the pigmentation to a large extent using lightening creams, including hydroquinone. I suggest you consult your dermatologist for a good lightening regimen suited to your skin.
In my dermatology office in Orange County, Fraxel Dual with thulium wavelength seems to do the best job treating hyperpigmentation resulting after IPL and laser burns. I would also recommend you use Elure to help remove the pigmentation and a good 4% hydoquinone product like Obagi to reduce the recurrence of pigmentation.
First, Asian skin is very demanding to treat safely for hair removal if the device or practitioner are compromised. I would not go back for a third burn.
The spots should resolve in time if there was not blistering. When they are healed, a bleaching cream is a possibility to decrease the pigment formation. Discuss this with a Plastic Surgeon or Dermatologist and they will get you on track with a 1064 laser, or 810 Diode which is the more safe and effective laser to treat ethnic skin.
Laser burn will occasionally happen even in the hands of the most experienced nurses working in the most reputable medical clinic under supervision of board-certified dermatologist or plastic surgeon. The key is to have laser procedures performed in a clinic where the supervising physician has good insight and experience in medical dermatology to step in when there is a complication involving laser burn. All skin types may be susceptible to pigmentary changes after laser burn though they tend to go away much quicker among fair skin individuals. You need to lubricate the affected area and minimize further irritation and achieve consistent sun protection within 10 days after laser burn; after pigmentation is becoming evident, work with a board-certified dermatologist to lighten pigmentation with combination of hydroquinone, glycolic acid, vitamin C.
The first question we have is why you would be considering having another treatment with this practitioner after two that led to burns? Either the practitioner does not know how to use the device or your skin type is not a good candidate for the treatment. Either way you should not be going back fo rmore treatments.
As for how to deal with the current burn:
First address healing with antibiotic ointment to prevent infection.
Keep the area covered from sunlight to prevent further pigmentation.
Check in with your practitioner at least every few days if there are issues with healing.
Once healed there are several options for PIH (hyperpigmentation). We use either and sometimes both to fix PIH problems.
Hydroquinone bleaching creams
q-switched laser treatments.
Finally, to address the issue of your ingrown hairs, IPL IS NOT the correct light based device. Long Pulsed Nd:Yg lasers are much safer and more effective for your skin type. We suggest getting through the current burn situation and recovery with the current practitioner and then switching to a practitioner with the correct laser system when you decide to continue with your hair removal.
These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.