Beware the Fitzpatrick! (Part 1)

by Trudy Fleming - CPE. Independent IPL Educator & Practitionerby Trudy Fleming - CPE. Independent IPL Educator & Practitioner

The amount of individuals suffering unnecessary burns from light based treatments is growing.
In many cases the burns are caused by the inappropriate energy levels used because of failure to correctly assess the clients Fitzpatrick skin type and failure to conduct appropriate test patch procedures prior to treatment. International expert Trudy Fleming shares insights and basic must dos to ensure this never happens to you.

Before performing a pulsed light or laser treatment, how many of you really assess your clients Fitzpatrick skin tone? And do you really understand why you are doing this or the repercussions for not doing it?
What about tan? Do you take into account the degree of tan each time a client has a treatment? Do you test patch each client at their consultation, then wait a number of days or weeks before starting a treatment program for hair removal or skin rejuvenation?
Getting these issues wrong cause more burns, blisters, hyper and hypopigmentation reactions than any other reason. There have been some very nasty incidents arising from pulsed light and laser hair removal and rejuvenation treatments in recent times. I feel therapists are not taking the initial assessment of the client seriously enough, or not getting this assessment correct. The outcome of all this is litigation, higher insurance fees, and clients that are scarred, temporarily or permanently, and not at all happy!
One of the optical properties of light, in our case from a laser or pulsed light system, is its ability to be absorbed by chromophores. What happens then depends on what type of tissue interaction occurs. In the case of hair removal and skin rejuvenation devices, a thermal action takes place, which means heat is produced. If this heating action is not controlled or is in an inappropriate area, then adverse reactions can occur.


Absorbtion levels of various chromaphores by specific light sources

The main chromophores that absorb light are: melanin, oxyhaemoglobin and water. The degree of absorption depends on the wavelength of light. For instance there is virtually no water absorption in the visible light spectrum but it rises fast in the infrared sector.
Melanin is absorbed to some degree or other across the whole light spectrum. There is however, higher melanin absorption in the ultra violet region then it gradually decreases as you pass through the visible section and into the infrared region.
Melanocytes, the cells that produce melanin granules, are found in the retina of the eye, the basal layer of the epidermis and in the hair papilla.

We need to ensure that clients, operators and anybody else in the room are wearing safety glasses to protect their eyes from any possible injury. There are people who feel that pulsed light is safer than laser so they dont wear eye protection. I feel this is a very foolhardy presumption. Over recent years I have received emails from various parts of the globe with complaints about eye problems following pulsed light treatment. The first one or two I put down to coincidence, but I have received too many reports to disregard them. Most are fairly minor complaints, inflammation, irritation, and increased sun sensitivity leading to red, runny eyes. Any reaction however small, needs to be taken seriously though. So, wear the correct eye wear at all times. There are new glasses on the market for pulsed light users. Clients can wear the normal green safety glasses, but there are now occulo plastic [lead lined] eyewear that fit closely to the eye, [shaped like solarium goggles] but highly protective. I like my clients to wear these when having hair removal on the face or upper body. There are also some disposable stick-on protectors called IPL AID which I use frequently, especially when performing a rejuvenation treatment, as you have more freedom to work on the upper cheek, temple and nose areas. There is also a similar product for laser use. Some operators complain they cant see well through the green IPL operator glasses, so they may like to try the photosensitive glasses that shut dark when the light flashes, a bit like welders glasses. These are heavier on the nose, but I prefer to use them these days. Most machine suppliers will stock these accessories.

Melanin production responds to ultra violet exposure and gives us our intrinsic skin colour and the degree of tan on our skin. Melanocytes reside in the basal layer of the epidermis. These dendritic cells make up about one in ten of the cells in this layer, and are in contact via their dendrites with about 30 surrounding keratinocytes. Melanocytes produce melanosomes, which travel along the dendrites carrying melanin granules and drop them off, via synapses onto surrounding keratinocytes, where they enter the cell and sit over the nucleus protecting it from ultra violet light. 
To remove hair with pulsed light we are targeting melanin within the hair shaft, but to get there, the light is passing through the epidermis and if there is significant skin colour [intrinsic or tan] the light will respond to it causing possible pageantry problems i.e. burns, blisters, hyper or hypopigmentation.
To avoid these problems we need to be able to assess the degree of intrinsic skin colour and tan. 
This means a consultation is an absolute necessity along with test patches.

The Fitzpatrick skin type scale was developed by Dr Fitzpatrick to help with assessing the chances of developing skin cancer but it has also been successfully used by the laser and pulsed light industry. The Fitzpatrick scale divides skin up into 6 tones based on burn time. The burn time relates to natural skin colour and nationality. The Fitzpatrick skin type of a client does not change. People often confuse Fitzpatrick with tan. Your Fitzpatrick type is something you are born with and will die with, it does not change, but the degree of tan can change.

You need to know what Fitzpatrick skin type your pulsed light system or laser can treat easily without problems, and how you can alter machine settings, or what other things you can do to treat the darker more problematic skin types. When to say no is also vitally important. You will not be able to treat everybody and need to know when to refrain.
Tan is an even bigger issue to deal with than Fitzpatrick types. On exposure to sun [or solarium], ultra violet radiation stimulates melanocytes into producing more melanin; skin becomes darker and will therefore react more readily to laser or pulsed light. An old tan that is fading is a little easier to treat than a new tan. With a new, recent tan or sun exposure, the Melanocytes are still very excitable and active and can react radically to light from laser or pulsed light systems. I recommend no treatment for 6 weeks post sun exposure unless the area has been very well protected with sun block or suitable clothing. One also needs to protect the treated area from sun exposure for at least 6 weeks after treatment.


About the Author

Trudy Fleming is a renowned personality with more than 40 years of industry experience, both clinically and as an educator. She has a national and international profile as a trainer with a passion for learning and passing on that knowledge in an easy-to-understand format and manner. Trudy has an abundance of knowledge, passion and energy to impart to those wanting the best in light-based aesthetic education.


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