Case Report
Freckles Removal Using Intense Pulsed Light
in Chinese People
October 2007
© October 2007 DEKA s.r.l – Release 2007_10_2
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Freckles Removal Using Intense Pulsed Light in Chinese People
Hangyan Shi， Meihua Wu， Sufan Wu
Department of Plastic Surgery， Zhejiang Provincial People’s Hospital， P.R.China
freckles, they may need to remove the
pigmented lesions for aesthetic purpose.
Some methods were reported for treatment of
freckles, including dermabrasion, chemical
peeling, topical tretinoin and laser treatment
using CO2 laser or Q-switched 755nm and
532nm laser. Although these therapies do
work, they need much recovery time and have
such side effects as scarring, hyperpigmentation or hypo-pigmentation. So it is
necessary to search a new method less
ablative and time-costly, with less pain or
minimal side effects, and high satisfaction.
Intense pulsed light (IPL) systems are
high intensity pulsed sources which emit
polychromatic light in a broad wavelength
spectrum. The mechanism of action of such
light systems corresponds to the selective
photothermolysis. As we know, when IPL is
irradiated to the skin, the pigmented tissue
may absorb more of the light energy whereas
other normal tissues don’t. So the temperature
of the pigmented tissue may rise in a short
period of time, to about 80 centigrade. So the
freckles may be destroyed and got rid of. At
the same time, the IPL systems cause no
damage to the normal part of the skin.
The research began in 2003, satisfactory
results were achieved with few side-effects. It
has become an effective method for the
treatment of freckles.
ABSTRACT
Background Freckles are a common skin
disorder among the Chinese people. Patients
may need to remove them for aesthetic
purpose. Besides dermabrasion, chemical
peeling and laser treatment, more effective
approaches have been always searched for.
Intensive pulse light (IPL) has been
considered as a novel approach to treat
freckles, which are less ablative, less timecostly, with less pain or minimal side effects.
Objective To study the effectiveness and the
proper parameters for the treatment of
freckles in Chinese people using IPL.
Methods Two hundred and fifty five patients
with facial freckles were treated by an IPL
system with a wavelength of 500—950 nm.
The
double-pulsed
illumination
was
administered with a power density of
11.0~15.5 J/cm2, a pulse width of 3.0~4.5 ms,
a pulse duration of 30-50 ms. The results were
evaluated independently by two attending
physicians six months after sessions,
according to the percentage of removed
freckles. Results Among 225 patients, 93
cases (36.47%) were excellent, 126 cases
(49.41%) were good, 29 cases (11.37%) were
fair and 7 cases (2.75%) were poor.
Conclusion IPL is an effective and safe
method for removal of freckles in Chinese
people.
METHODS
INTRODUCTION
A total of 255 patients with freckles on the
face were treated, aging from 16 to 58. Six
were male and 249 were female. Skintypes
are Fitzpatrick III-V, all without history of
sunlight allergy.
DEKA® IPL system was adopted. Its
wavelength is 500~950nm. The double-pulsed
illumination was administered with a power
Freckles are common cutaneous disorder.
They are flat tan or brown and black spots on
the skin, which usually appear on the face and
chest. Evidence shows that they are a result
of mortality in combination with overexposure to the sunlight. In some areas of the
world, people may take freckles as a “cute”
sign. But in China, most people regard that
beautiful skin is clean and white without
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density of 11.0~15.5 J/cm2, a pulse width of
3.0~4.5 ms and a pulse duration of 30~50 ms.
Before treatment, the skin of face was
thoroughly cleaned with cleanser. Cooled and
transparent gel was applied to the area to be
treated. The handpiece moved gently through
the skin, delivering precise pulsed light. Skin
cooling was recommended after treatment, in
order to lessen the skin flush. The patients
were asked to take 5 sessions, with an interval
of four weeks. After treatment, sun protection
is necessary. Sun block (SPF>30, PA+++)
was recommended.
No anesthesia was adopted during IPL
treatment. Some patients complained of the
feeling of burn while the pulsed light was
irradiated to the skin. Immediately after
treatment, skin flush or erythema could be
observed in the treated area, which lessened
in several hours or one day. On the next day,
the freckles darkened and formed thin
crusting, which usually detached from skin
within one week. Then the freckles could be
seen significantly “bleached”.
in sum and size when people get aging or are
exposed to more sunlight. Most of the
Chinese people regard that the freckles are
unhandsome that need to be treated.
Traditionally,
dermabrasion,
chemical
topical tretinoin,5 and laser
peeling,4
treatment using CO2 laser6 or Q-switched
755nm7 and 532nm laser8 were adopted to
remove freckles. But to Chinese people whose
skin types are Fitzpatrick III~V, these ablative
and invasive therapies have risks of
inflammation, hyperpigmentation and even
scarring. It is reasonable that the nonablative
method would be suitable for the patients with
a type of Fitzpatrick III~V. According to the
mechanism of IPL, it is a kind of nonablative
treatment for skin pigmentation. When a
precise light is delivered to the skin, the
pigmented tissue may absorb more of the light
energy whereas other normal tissues don’t. So
the temperature of the pigmented tissue may
rise in a short period of time, to about 80
centigrade,9,10 which brought about selective
pigmented tissue injury without epidermal
damage. Then the freckles may be destroyed
and got rid of. At the same time, the IPL
causes no damage to the normal part of the
skin.
Intense pulsed light (IPL) systems are high
intensity pulsed sources which emit
polychromatic light in a broad wavelength
spectrum of 500~1200 nm.11 As we know, the
using of visible light (400~800 nm) is the
main power for treatment of skin
pigmentation. On the other hand, when a light
affects on the tissue, the longer the
wavelength is, the deeper the light penetrates
into tissue. For the treatment of the superficial
pigmentation such as freckles, the light with a
wavelength longer than 900 nm will have no
effectiveness but possible to damage the
deeper normal tissue. The DEKA® IPL
system chosen in this study emits noncoherent
light with a wavelength of 500~950nm, which
is an important advantage that differs from the
traditional IPL ranging from 500~1200 nm.
The infrared part of light ranging from 950 to
1200nm was filtered in DEKA® IPL system.
Compared with traditional IPL, the
500~950nm IPL caused less pain and flush
during treatment. 12,13
RESULTS
Six months after the five-session
treatments, the results of the treatments were
evaluated independently by two attending
physicians according to the following criteria:
Excellent: over 80% freckles disappear, and
the result lasts for more than 6 months. Good:
over 60% freckles disappear, and the result
lasts for more than 6 months. Fair: over 40%
freckles disappear, and the result lasts for
more than 6 months. Poor: over 40% freckles
remain, or the result lasts less than 6 months.
The results of this study were that: 36.47%
excellent (93 in 255); 49.41% good (126 in
255); 11.37% fair (29 in 255) and 2.75% poor
(7 in 255).
No blistering, scarring or hypopigmentation
has been observed. Hyperpigmentation is rare.
DISCUSSION
Freckles are a result of inheritance in
combination with skin over-exposure to
sunlight. 1,2,3 Freckles may darken or increase
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During the treatments, double-pulsed IPL
irradiation was adopted, with the power
density of 11.0~15.5 J/cm2, power width of
3.0~4.5ms, power duration of 30~50ms. In
patients with darker skin (Fitzpatrick IV~V),
we adopted lower power densities (11.0~14.0
J/cm2), longer pulse widths (3.5~4.5 ms) and
longer pulse durations (40~50ms). In patients
with brighter skin (Fitzpatrick III~IV), we
adopt higher power densities (13.0~15.5
J/cm2), shorter pulse widths (3.0~4.0 ms) and
shorter pulse durations (30~40 ms). As
sessions go on, freckles diminish and the
power density and pulse duration were
adjusted to the new circumstance. We found
that the most significant improvement was
usually achieved during the first one or two
sessions. This maybe caused by the great
difference between the freckles and the
normal skin at the time of the beginning of the
treatment. Goldberg D reported the
observation of new collagen formation in
dermis after IPL treatment. 14 It was also
found that in many patients, the IPL can also
improve the skin texture, make it smoother
and have the effect of skin rejuvenation. Also,
we observed that much of the hair on cheeks
or around lips was removed at the same time.
IPL is efficient to the removal of freckles.
It is almost painless, and costs no recovery
time, but it still has its limits. Due to the large
handpiece and strong light, the freckles on the
eyelid and elbow were difficult to be treated,
where the QS755 nm laser could be used as
an alternative. The handpiece can be easily
administered in flat areas such as the cheeks
and the forehead, but not so easy around the
nose. The “bleached” freckles may darken a
little compared with the skin immediately
after sessions even the patient underwent
strict sun protection. Stratigos AJ reported
that cholasma can be improved by many ways
of treatment but often recur. 15 In the patients
complicated with cholasma， although we
adopted low-fluenced IPL, and there were no
blistering or significant crusting or sunexposure, the pigmentation sometimes recur
or even worsened. Then the treatment was
abandoned.
IPL is an efficient method to remove the
freckles for the Chinese people. It is
necessary to take a longer follow-up. If
possible, the pathology changes need to be
researched.
REFERENCES
1.Rees J. Genes for freckles. J Invest Dermatol.
2004;123(2):414.
2. Zhang XJ, He PP, Liang YH, et al. A gene for freckles
maps to chromosome 4q32-q34. J Invest Dermatol.2004;
122(2):286-290.
3. Bataille V, Snieder H, MacGregor AJ, et al. Genetics of
risk factors for melanoma: an adult twin study of nevi and
freckles. J Natl Cancer Inst. 2000;92(6):457-463.
4. Cotellessa C， Peris K， Onorati MT， et al. The use of
chemical peelings in the treatment of different cutaneous
hyperpigmentations. Dermatol Surg..1999; 25(6):450454.
5. Samuel M, Brooke RC, Hollis S, Griffiths CE.
Interventions for photodamaged skin. Cochrane Database
Syst Rev.2005; (1):CD001782.
6． Ozbayrak S, Dumlu A, Ercalik-Yalcinkaya S. Treatment
of melanin-pigmented gingiva and oral mucosa by CO2
laser. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod .2000; 90(1):14-15.
7. Jang KA, Chung EC, Choi JH, et al. Successsful removal
of freckles in Asian skin with a Q-switched alexandrite
laser. Dermatol Surg. 2000;26(3):231-4.
8. Rashid T, Hussain I, Haider M, Haroon TS. Laser therapy
of freckles and lentigines with quasi-continuous,
frequency-doubled, Nd:YAG (532 nm) laser in Fitzpatrick
skin type IV: a 24-month follow-up. J Cosmet Laser
Ther.2002; 4(3-4):81-85.
9. Anderson RR, Parrish RR. Selective photothermolysis:
Precise microsurgery by selective absorption of pulsed
radiation. Science. 1983;220:524-527.
10. Goldman MP, Eckhouse S. Photothermal sclerosis of leg
veins. Dermatol Surg. 1996;22:323-330.
11. Raulin C, Greve C. IPL technology: a review. Lasers
Surg Med. 2003;32:78-81.
12. Huang YL, Liao YL, Lee SH, Hong HS. Intense pulsed
light for the treatment of facial freckles in Asian skin.
Dermatol Surg.2002; 28(11):1007-1012.
13. Wang CC, Hui CY, Sue YM, et al. Intense pulsed light
for the treatment of refractory melasma in Asian
persons. Dermatol Surg. 2004;30(9):1196-1200.
14. Goldberg D. New collagen formation after dermal
remodeling with an intense pulsed light source. J Cut
Laser Ther 2000;2:58-61.
15. Stratigos AJ, Katsambas AD. Optimal management of
recalcitrant disorders of hyperpigmentation in darkskinned patients. Am J Clin Dermatol. 2004;5(3):161-8.
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Fig. 1A
Fig. 1B
Figure 1
An 18-year-old female with freckles
was treated with IPL and obtained an excellent
result. 1A – Before treatment. 1B – After 2
sessions, the freckles were significantly removed.
1C – After 4 sessions, most of the freckles were
removed.
Fig. 1C
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Fig. 2A
Fig. 2B
Figure 2
A 27-year-old male with freckles was
treated with IPL and obtained an excellent result.
2A - Before treatment. 2B - After 2 sessions, the
freckles were significantly removed. 2C - Nine
months after the last session, freckles did not recur.
Fig. 2C
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