Treatment of telangiectasia in surgical scars on the face with intense pulsed light: case series

Submitted on: 15/02/2023
Approved on: 27/07/2023
Financial support: None.
Conflict of interest: None.
How to cite this article: Toledo C, Matsuura NC, Santana VLM, Brandão TA, Pessotti NS. Treatment of telangiectasia in surgical scars on the face with intense pulsed light: case series. Surg Cosmet Dermatol. 2023;15:20230227.

Abstract

Intense Pulsed Light (IPL) is an effective technology to treat vascular lesions, pigmented lesions, and photorejuvenation, among other indications. In the case of telangiectasia, its mechanism of action is based on photothermolysis of the vessels, inducing intravascular coagulation. We report three cases where IPL was used to treat telangiectasia in a surgical scar, showing good aesthetic results after three sessions.

Keywords: Cicatrix; Telangiectasis; Intense Pulsed Light Therapy; Erythema

INTRODUCTION

Intense pulsed light (IPL) is a technology created to treat vascular lesions, pigmented lesions, and other applications, such as hair removal and photorejuvenation. It became a very versatile tool in Dermatology by producing single or multiple synchronized pulses at a wavelength of 400-1200 nm and with the possibility of varying the duration of these shots.¹

This study aims to demonstrate the use of IPL therapy in scars on the face, targeting to reduce erythema and the presence of telangiectasia. We report three cases where we used IPL therapy in the scar region, with good aesthetic results.

METHODS

Three patients reporting aesthetic discomfort with the scar on their face after surgical excision of basal cell carcinoma (BCC) underwent IPL treatment (Table 1).

Patient 1: A 61-year-old man presented a grayish papule on the tip of the nose. We performed an incisional biopsy with an anatomopathological report of nodular and micronodular BCC. Surgical excision was performed using the advancement flap reconstruction technique (Figure 1).

Patient 2: A 64-year-old woman had an erythematous papule with a pearly sheen on the left epicanthus. We performed an incisional biopsy with an anatomopathological report of expansive nodular BCC. Surgical excision was conducted with Mohs micrographic surgery associated with the rotation flap reconstruction technique (Figure 2).

Patient 3: A 58-year-old woman presented an erythematous papule with a pearly sheen on the nasal dorsum. We performed an incisional biopsy with an anatomopathological report of sclerodermiform BCC. Mohs micrographic surgery was conducted with primary wound closure (Figure 3).

After surgical treatment, all three patients reported aesthetic discomfort with the surgical scar, with local erythema and telangiectasia. We treated the surgical scars with intense pulsed light (Etherea^® Platform) in three sessions at monthly intervals. During treatment with intense pulsed light, patients used chemical sunscreen with a sun protection factor (SPF) 50 daily.

RESULTS

The three patients evolved with good aesthetic results, evidenced by reduced erythema and telangiectasia in the scar region.

DISCUSSION

The present report demonstrated that treatment with IPL is effective in improving the clinical appearance of patients with facial telangiectasia, with minimal and transient adverse events.^2,3

IPL is an effective and safe therapeutic option for rosacea and telangiectasia. IPL treatment stimulates superficial collagen and elastic fibers in the dermis. It is due to the selective absorption of light by tissue water, increasing heat conduction around collagen and, consequently, its production. Also, there is an increase in fibroblasts production due to the photothermal effect.⁴

This type of therapy destroys dilated blood vessels and reduces inflammation levels, contributing to an overall improvement in skin quality.⁵

CONCLUSION

IPL treatment is a safe and effective therapeutic option for improving the aesthetic appearance of surgical scars.

AUTHORS' CONTRIBUTION:

Cibele Toledo
ORCID: 09-0005-1014-7705
Preparation and writing of the manuscript; collecting, analyzing, and interpreting data; critical literature review.
Naomi Carrara Matsuura
ORCID: 00-0001-5097-6851
Preparation and writing of the manuscript; collecting, analyzing, and interpreting data; critical literature review.
Victoria Linhares Maia Santana
ORCID: 09-0000-6597-1463
Preparation and writing of the manuscript; collecting, analyzing, and interpreting data; critical literature review.
Talita Andrade Brandão
ORCID: 00-0003-4948-5144
Effective participation in research guidance; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases.
Nabila Scabine Pessotti
ORCID: 00-0003-0879-2981
Approval of the final version of the manuscript; study design and planning; effective participation in research guidance; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical literature review; critical review of the manuscript.

REFERENCES:

1. Kalil CLPV, Reinehr CPH, Milman LM. Intense Pulsed Light: review of clinical indi cations. Surg Cosmet Dermatol. 2017;9(1):9-17.

2. Lim HS, Lee SC, Won YH, Lee JB. The efficacy of Intense Pulsed Light for treating erythematotelangiectatic rosacea is related to severity and age. Ann Dermatol. 2014;26(4): 491-5.

3. Gade A, Vasile GF, Rubenstein R. Intense Pulsed Light (IPL) therapy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580525/

4. Luo Y, Luan X-L, Zhang J-H, Wu L-X, Zhou N. Improved telangiectasia and reduced recurrence rate of rosacea after treatment with 540 nm-wavelength intense pulsed light: a prospective randomized controlled trial with a 2-year follow-up. Exp Ther Med. 2020;19(6):3543–50.

5. Yepuri V, Patil AD, Fritz K, Salavastru C, Kroumpouzos G, Nisticò SP, et al. Light-based devices for the treatment of facial erythema and telangiectasia. Dermatol Ther. 2021;11(6):1879–87.