Do I have IPL laser hypopigmentation? (photo)

Question

I had IPL 1 week ago on my chest for hyperpigmentation. Should I be worried now about post treatment hypopigmention? Directly after the treatment I had erythema and blisters. I was told to ice and treat the area like a burn. I week later the area treated still has railroad track like lesions.

Larry S. Nichter, MD, MS, FACS · Answer

IPL ( intense
Pulse-Light) treatments can give varying results from treatment to treatment
depending on how much pigmentation correction is needed. We
refer to the blotches you refer to immediately after treatment as
"coffee grounds" effects. These are most likely sun-damaged
layers in the epidermis that will slough off within the first 1-2 weeks.
Deeper pigmentation will continue to resolve over time and with
successive treatments.l
We find
that the Sciton laser is exceptionally effective at treating with Broad Band Light (BBL) for most skin
types for sun-damaged and uneven skin color.#BBLlasertreatments #IPLtreatments #pigmentationtreatments

Jeff Angobaldo, MD · Answer

thank you for your question.  IPL treatment treats red vessels, hyperpigmentation and it improves the texture of your skin by producing collagen and elastin. you will pepper after the treatment and the dark spots will appear darker before they flake off. do not be alarmed.  This takes 2-4 days depending on your skin type and the intensity of the treatment.Always consult with a physician to make sure you are a good candidate.

Raffy Karamanoukian, MD, FACS · Answer

Our protocol for hyper-erythematous redness uses a combination of lasers and Nanofractional RF to help reduce localized and perfuse hypervascularity in the skin. We begin with an evaluation of the redness and evaluate the cause of the hypervascularity. Treatments with Limelight IPL, Vbeam Perfecta, and Nanofractional RF are then used to reduce the blood vessels and telangiectasia within the skin. Patients benefit from post-treatment application of Elevase Moisture Booster with ceramides. 
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

R. Brannon Claytor, MD, FACS · Answer

In the industry, an IPL treatment can have this type of outcome on the chest area when treating on skin that has not been properly conditioned. Skincare products are always used on the face and not brought down to treat the neck and chest. Also the chest skin is thinner than the skin on the face and special attention is necessary when treating IPL on the chest. However, by using IPL to correct the hypopigmentation by blending and treating the surrounding Hyperpigmentation. Also microdermabrasion and chemical exfoliation with hydroquinnone can help make the branding less apparent.

Jed H. Horowitz, MD, FACS · Answer

IPL ( intense
Pulse-Light) treatments can give varying results from treatment to treatment
depending on how much  pigmentation correction  is needed.   We
refer to the blotches you refer to immediately after treatment as  
"coffee grounds" effects.  These are most likely sun-damaged
layers in the epidermis that will slough off within the first 1-2 weeks.
 Deeper pigmentation will continue to resolve over time and with
successive treatments.l
We find
that the Sciton laser is exceptionally effective at treating  with Broad Band Light (BBL) for most skin
types for sun-damaged and uneven skin color.#BBLlasertreatments   #IPLtreatments  #pigmentationtreatments

Steven H. Williams, MD · Answer

You will likely have pigment changes due to the burns from the IPL treatment. The best way to minimize the damage is to apply aquaphor to the scabbed areas until they are completely healed and definitely avoid sun exposure on these areas while they are healing. Hypopigmentation may improve over a long period of time, but it can be permanent as well. Hyperpigmentation can also improve over time and with the use of lightening creams and sunblock. Follow up with your clinician to make sure things are healing properly and definitely make sure settings are more conservative if you are doing future treatments. Always make sure to let your clinician know of any changes in your health or medications prior to any treatment and if you have had recent sun exposure. This can help guide the treatment setting selection to reduce your chances of adverse reactions.

Christopher T. Maloney Jr., MD · Answer

Thank you for your question.Unfortunately you had a very poor outcome that was avoidable.Don’t pick your scabs and treat this like a
burn.You need to find an experienced
professional to correct this.Find
someone who does a lot of IPL /BBL and has experience correcting problems like
this.I wish you the best, and do your
homework finding the right professional to help you take care of this as it
will likely be several treatments.

David W. Kim, MD · Answer

I am very sorry to hear that you had this result from an IPL. Unfortunately the skin on the chest tends to be thin, sensitive and darker in pigmentation requiring conservative settings.

	 

	Allow your skin to heal for at least 2-3 months with an occlusive ointment, no picking and diligent SPF use. Once the skin has settled with less "pink" it can be distinguished as hypopigmentation/hyperpigmentation. Hypopigmentation will not resolve completely. The area can soften over time but this can take months. The practitioner can use more conservative settings and go the other other way to minimize the demarcations. Pre-treatment with hydroquinone can be done to lighten the skin prior to these sessions and minimize adverse reactions.

Sonia Badreshia-Bansal, MD · Answer

If you did not blister, and are not dark in skin color, the Hypopigmentation should be transient. It is easy to remove pigment from the chest, so lower settings are a good place to start. With the second treatment, the Hypopigmented lines will fade as more pigment is removed. If blisters or prolonged redness were present, the settings need to be turned down a bit.

Harold J. Kaplan, MD · Answer

Based on the picture you submitted, it looks like you have done a good job making sure that this injury heals well.  Keep the area moist with neosporin and make sure to STAY OUT OF THE SUN.  Do not pick or peel the scabs off, allow the skin to flake off naturally.
The area is pink underneath and will remain that way for a while while you heal.  Based on the healing response so far, it does not appear that you will be hypopigmented from this trauma, but only time will tell for sure.  Even if the area appears to be healed some time from now, try to stay out of the sun completely for at least 6 months. You should also check in periodically with your treating physician to monitor your progress.
Next time may we suggest Pulsed Dye Laser treatments for chest redness and q-switched Nd:Yg lasers for the brown pigment.  The problem with IPL treatments for your condition is that the type of light energy used is not specific to either red or brown but is generic.  That is why the incidence of side effects like this is higher with IPL treatments than with lasers.

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