Epiluminescent Microscopy Predicts the Efficacy of Intense Pulsed Light Treatments in Asian Skin

Introduction: Facial dyschromias, particularly in Asian skin, represent a challenge to cosmetic surgeons. Intense pulsed light (IPL) has been reported to clear a number of pigmentary alterations, but we have found the results variable and the efficacy of treatment difficult to predict. Objective: To use epiluminescent microscopy (ELM) to predict the clearing of clinically pigmented lesions in Asian patients undergoing “fotofacials” with IPL. Methods: Clinically similar pigmented lesions on the face were photographed with standard techniques and with ELM before, during, and after multiple IPL treatments in 5 patients. Patients and physicians were asked to grade cosmetic improvement after 5 sequential treatments. ELM photographs were then evaluated after treatment to correlate clinical success with the type of lesion. Results: ELM was able to discriminate among several clinically similar lesions. Lentigines responded to IPL treatments, whereas macular seborrheic keratoses, melasma, and junctional nevi responded poorly. Conclusion: Careful evaluation of pigmented lesions in Asian skin before IPL treatment can predict the efficacy of treatment.