SANTA MONICA, CALIF. The ideal device for treating pigmentation disorders would reduce wrinkles, pigment, and redness in one pass with a low amount of pain and give patients a fast, easy recovery, according to Dr. E. Victor Ross.
"There's no device that does all those things, but the devices that actually selectively target blood and melanin are possibly the closest thing to it," Dr. Ross said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).
Dr. Ross of the Scripps Clinic in San Diego discussed the pros and cons of using intense pulsed light (IPL) devices, pulsed dye lasers (PDL), and potassium-titanyl-phosphate (KTP) lasers for treating pigmentation disorders.
Both pigmentation and vascular disorders can be treated in one pass using IPL therapy and KTP lasers, he said. The PDL was the first "boutique laser" to treat vascular lesions, he noted. Next came the KTP laser to treat isolated vessels. When IPL treatment entered the scene, it displaced the other devices because of its versatility, but all three approaches have a role in treating blood and pigment lesions. "My favorite on a daily basis is the KTP laser," he acknowledged.
PDL treatment is fast, and if a patient doesn't mind the resulting purpura, the PDL is probably the best device for improvement of redness in a single treatment, said Dr. Ross.
The PDL remains the standard for treating port wine stains. Nevertheless, it is not possible to reduce both red and brown facial lesions with this laser, and it cannot, in one pass, treat both blood and pigment lesions.
KTP lasers can treat both small and large spots. The spot-size reduction allows for safer treatment of darker-skinned (skin types IV and V) patients with telangiectasias. In addition, the device has a good vascular-to-pigment damage ratio. When a 1- to 5-mm spot size is used, vessel reduction can be seen in real time.
"It is nice to see a blood vessel disappear as you see it, which you can't do with the IPL," said Dr. Ross. "It's just fun to do." The handpiece is also light and easy to use.
KTP therapy has higher costs, however, and tends to cause more pain than IPL treatment. After KTP treatment, edema can be severe, and overtreatment can cause pitting.
IPL therapy is raising the bar for treating pigmentation. Filtration is better with an IPL device, lamp pumping is smoother, cooling has been added to the device, and the radio frequency has been improved. Most importantly, it is safe, he said.
One of IPL's drawbacks is that the divergence of the beam means the handpiece must be held close to the skin, which may compress vessels. Also, the nonlaser properties of IPL make it difficult to focus on small spots, so it can be challenging to use on discrete lesions. Finally, with large spot treatment capability comes the potential for big side effects, Dr. Ross noted.
He disclosed being a consultant for, and receiving research grants from, Palomar. Dr. Ross also has received research support from Cutera Inc., Lumenis, Candela Corp., Ulthera Inc., and Sciton Inc.
SDEF and this news organization are both owned by Elsevier.
My favorite laser on a daily basis for treating pigmentation disorders is the KTP. DR. ROSS