Case Study: Treating Solar Lentigines

Age spots or solar lentigines are a common skin concern for those looking to achieve skin rejuvenation. They are usually flat, pigmented lesions commonly found on sun-exposed areas such as the face, neck, chest and hands and are induced by UV light exposure.¹ Their treatment can be broadly split into topical and physical therapy. Topical options include agents such as retinoids, cysteamine or hydroquinone. Physical treatments include cryotherapy or laser treatments.² A newer modality available for the treatment of solar lentigines includes broadband light (BBL). Whilst intense pulsed light (IPL) treatments have long been used to address common skin concerns associated with sun exposure, BBL offers an advancement on IPL technology with increased safety, efficacy and speed.³ This article aims to inform the reader on what BBL is and present a case where it has safely been used to treat solar lentigines.

A new technology

While BBL is new to the UK through the BBL Hero device, the technology was first introduced in 2004 and is well adopted throughout the world.³ It is commonly used for skin rejuvenation by clearing pigmented lesions, diffusing redness and treating thread veins and active acne. The technology is also highly capable for permanent hair reduction in skin types I-V by utilising either a stamping or ‘in-motion’ technique.⁴ Corrective skin rejuvenation treatments are offered in a series of three to five treatments spaced four to six weeks apart. BBL is often safely combined with other skin rejuvenation treatments such as microneedling, medical-grade facials, fractional laser and radiofrequency microneedling in a single session.⁴

BBL vs IPL

BBL is an advanced IPL technology that utilises light in the visible and infrared spectrum.⁵ It is important to note that like IPL, BBL is not a laser, and its light encompasses a range from 400 nm to 1400 nm. Faster treatments are possible with BBL.⁶ BBL emits multiple wavelengths within a band of light, allowing multiple targets to be treated at the same time.⁶ The light is generated from dual xenon flashlamps within the handpiece and delivered to the tissue via an electronically cooled sapphire crystal.⁶

Case study

Consultation

A 69-year-old patient with Fitzpatrick type II skin attended the clinic as they had noticed a proliferation of age spots and uneven pigmentation on their skin. She felt that they had appeared relatively recently and was concerned with the ageing effect they had on her appearance. The patient split her time between the UK and the south of France and previously had not always been regimented with sunscreen application, so had a fair amount of UV exposure. A large portion of the consultation process was a discussion and education of the patient with regards to the effects of UV damage on the skin, and the need for regular high factor 50, broad-spectrum sunscreen to protect the skin going forward. Any treatments to solve her solar lentigines would rely on ongoing sunscreen use to protect her results and prevent further formation of other lesions. It would also help reduce her risk of forming more lesions such as skin cancers that could have an even greater impact on her health. I examined the patient’s lesions with the ABCDE rule and concluded no abnormalities. 

Whilst there are many ways of addressing skin tone and pigmentation including chemical peels and at-home use of medical-grade skincare options, including products containing cysteamine, the patient was keen to go for a procedure that could be carried out in-clinic, with little downtime or side effects and using a treatment where she would see the results quickly. We opted for BBL as, other than a darkening of existing pigment, there is little downtime or side effects seen.⁴ The treatment could be carried out quickly with no need for at-home skincare other than using a good quality sunscreen. I advised the patient that whilst she would see an improvement after one treatment, I personally believe that three treatments are generally required to provide a more long-term result, with the need for one to two maintenance treatments per annum.

Treatment

We carried out a course of three treatments using BBL to the patient’s face. Informed consent was gained, and a consent form signed. A pre-treatment Visia skin analysis was carried out to gain reproducible baseline imaging. The skin was cleansed and disinfected using Clinisept+ Prep & Procedure. A water-soluble ultrasound gel was applied to the face for use as a coupling agent between the BBL handpiece and the skin. Some test areas were carried out to ensure clinical endpoints were being achieved (such as darkening of pigmentation). We carried out the treatment with two all over passes using the 515 nm filter, seven Joules/cm2 fluence, 3.0ms pulse width and 28 degrees cooling. The 515 nm filter was used to specifically target the pigmentation in this patient. For the third pass we spot-treated the solar lentigines using the corrective mode for pigmented lesions with the 515 nm filter, nine J/Cm2 fluence, 20 msec pulse width and 20 degrees cooling.

Results

I reviewed the patient after two weeks following the first treatment. She reported she had not had any noticeable downtime after the procedure. As expected, the solar lentigines had initially darkened then had flaked off gradually over the week following the procedure. We repeated the treatment twice more at approximately two weekly intervals. At the end of the treatment course, we repeated the patient’s Visia skin analysis. She had achieved a 52% improvement in skin tone (spots) as a result of the treatment. As well as a reduction in solar lentigines, this patient also noticed improvements in tissue laxity.

Successful treatment depends on a combination of time and temperature to achieve collagen denaturation.⁸ After a series of up to five treatments, this denaturation results in new collagen deposition and shrinkage.⁸ Popular treatment areas include the crow’s feet, lower face, neck, chest, hands, abdomen and above the knees. In addition to treatment technique, the practitioner must select the right candidates and set proper expectations to ensure best results. Ideal candidates have an appropriate amount of laxity (too much could be more of a surgical case) and understand the full series must be completed.

Considerations and side effects

As with any energy-based device, there are considerations a practitioner should take to avoid adverse outcomes when using BBL. The most common contraindication seen is actively tanned skin. A patient with an active tan must not be treated for at least two weeks without sun exposure to avoid hyperpigmentation which can happen as a result of treating tanned skin. Other contraindications include natural, or medication-related light sensitivity, use of isotretinoin within six to 12 months, patients with medical conditions that affect wound healing, history of skin cancer and any active infection.⁷

Another consideration is treatment of non-facial tissue which tends to be thinner and more sensitive to heat. In these areas, decreased fluence and increased cooling may be necessary. Suspicious lesions should never be treated, and the patient should be referred to an appropriate dermatologist for further examination.⁷

Tattooed areas should be strictly avoided as the ink may absorb energy, resulting in colour change to the ink or a burn. Oedema around the eyes and bridge of the nose may occur immediately after a BBL treatment and remain for 24-48 hours.⁷ Purpura may occur in treated areas lasting for one to two weeks and is usually the result of too high of a fluence or too short of a pulse width. Hyperpigmentation may occur and, although all skin types can be treated with BBL, there is a high risk in darker skin types. It is normal for a patient to have a tingly sunburn sensation which may last up to 24 hours post-treatment.⁷

An advancement of IPL

As well as improving solar lentigines and common skin concerns associated with photoageing, BBL offers a wide variety of treatments in a single technology. A proven foundation of skin rejuvenation therapy combined with innovative treatment enhancements make BBL an advanced treatment protocol.