By Bob Kronemyer; Reviewed by Robyn Siperstein, MD
Broadband light is an efficacious modality to treat senile purpura that causes only limited pain and requires minimal downtime.
Broadband light is an efficacious modality to treat senile purpura that causes only limited pain and requires minimal downtime.
“The purpura slowly goes away over the course of 24 to 48 hours,” said Robyn Siperstein, MD, founder of Siperstein Dermatology Group in Boca Raton and Boynton Beach, Florida, who presented the results of a pilot study using broadband light to treat senile purpura at the annual meeting of the American Society for Dermatologic Surgery (ASDS), which was held virtually in October. Unlike skin resurfacing, broadband light therapy does not require the patient to stay inside afterward.
“Patients may appear a little red and feel slightly hot for a couple of hours after treatment,” said Dr. Siperstein, “And if patients have sun damage, the sun damage becomes darker, then flakes off.”
Senile purpura is a common condition in Florida, due to sun exposure, and is particularly prevalent in Boynton Beach because of the many communities for people aged 55 and older. People who currently take steroids or blood thinners are also at higher risk of acquiring the skin condition.
Dr. Siperstein prefers the term “senile purpura” or “dermatoporosis,” as opposed to “actinic purpura,” because this term denotes that the purpura is from sun damage only, when in reality sun damage is not the only cause.
“Currently, there are limited treatment options for senile purpura,” said Dr. Siperstein. The 3 most common topical options are retinol, arnica, and vitamin K, “But studies have been inconclusive for efficacy,” she said. “Some of the studies did not have a control group, which is important because multiple studies have shown improvements with just a base vehicle cream. Other studies had controls but had contradictory findings.”
Dr. Siperstein started using the Sciton broadband light 5 years ago on patients who were bruising after cosmetic procedures. Shortly thereafter, one of her female patients being treated for bruising after a cosmetic procedure asked the doctor if she could treat the senile purpura on her arms as well.
However, lesions on the legs are much harder to treat, as legs take much longer to heal.
Study details
Dr. Siperstein was principal investigator of a 10-patient study that compared 5 subjects over the age of 65 with ecchymotic lesions measuring over 1 cm on each forearm to 5 younger subjects under 35 years of age without any ecchymotic lesions.
All patients were treated at Dr. Siperstein’s practice by her and Jennifer Richter, PA-C, in 2018.
The protocol consisted of 4 weekly sessions of broadband light treatment. Photographs taken before treatment and 1 month after the completion of the final session. Skin biopsies taken 1 day after the final session were analyzed.
The number of ecchymoses on the treated vs untreated arm were significantly reduced (P = 0.02), with an average reduction of 3.5 lesions.
The square area of ecchymoses on the treated vs untreated arm were also significantly reduced (P = 0.04), with an average reduction of 12.7 cm.
All subjects, even those on blood thinners and inhaled or injected corticosteroids, had at least a 50% reduction in the total square area of ecchymoses.
No side effects lasted more than 30 days.
Broadband light treatment of older skin with senile purpura (green) also resulted in a 21.14% increase in epidermal thickness compared to untreated older skin (P = 0.0153, 2-tailed, paired t-test).
Treatment significantly increased epidermal thickness in elderly subjects (green) to levels comparable with young subjects (blue): 54.89 µm vs 53.82 µm.
To date, Dr. Siperstein has used broadband light to treat senile purpura in roughly 30 patients. “Nearly all patients have responded to treatment,” she said. “All patients on blood thinners and inhaled or injectable steroids did well. The only patients I find that do not do as well are those on oral steroids in high doses and for long periods of time.”
Patients without much sun damage are treated once a week for a total of 4 to 8 sessions, with both arms taking approximately 15 to 20 minutes per session.
Treatment technique
Treatment comprises several filters of broadband light, starting with multiple passes of a Sciton SkinTyte filter from 800 nm to 1400 nm at 150 watts in continuous motion, followed by 2 passes with a 590-nm filter at a lower energy setting, then a slightly higher energy setting of 2 passes with the same 590-nm filter. The final step is 2 passes with a 560-nm filter.
Each subsequent treatment session is tailored based on results of the previous treatment session. Maintenance therapy is also required once every 3 to 6 months.
“I have found that multiple passes, first at a lower energy, then increasing the energy, as well as changing to different filters to ensure that we are targeting different depths of the skin, help in senile purpura because that condition has bruises in many different stages,” Dr. Siperstein said. “There are often multiple colors that we are treating. Bruises can be purple, pink, red, yellow, or green.”
Too high of an energy setting will cause the skin to blister.
Dr. Siperstein shaves patients before treatment so that the energy is delivered deep into the skin and does not become trapped in the hair.
Ultrasound gel is also applied on the skin to glide the broadband light. “If you do not use gel and you glide something very quickly over someone’s arm with senile purpura, you will actually cause more bruising,” she said. “It is very important when treating this condition to ensure there is no friction.”
In addition, patients are instructed to not directly expose themselves to the sun 24 hours before treatment and to apply sunscreen both before and after therapy. “The more sun damage that is in the skin, the more the broadband light will be attracted to the pigment instead of the bruising,” said Dr. Siperstein, who is also a volunteer associate professor of dermatology at the University of Miami.
Sciton broadband light is a good investment for a dermatology practice, according to Dr. Siperstein, because the device can be used to treat a wide range of conditions, ranging from hair removal to removal of vascular lesions, sun damage, and brown spots.
“I believe broadband light will become the treatment of choice for senile purpura,” Dr. Siperstein said. “There are a lot of studies that show the therapy can increase collagen, increase epidermal thickness, and remove vascular lesions. Combining those 3 advantages make broadband light ideal for senile purpura because it is a condition of decreased skin thickness, increased bruising, and decreased collagen.”
Moreover, broadband light has a much broader treatment area than a laser, for much quicker treatment.
Disclosures
Dr. Siperstein has received research funding from Sciton Inc.
Commentary
Best outcomes for senile purpura
When treating senile purpura, it is important to promote moisture retention of the skin, according to Suneel Chilukuri, MD, the dermatologist at Refresh Dermatology in Houston, Texas. “Anything that rehydrates the skin and improves the water barrier will improve the overall health of the skin,” he said.
Three inexpensive, over-the-counter products that are quite effective for senile purpura are CeraVe, Cetaphil, and Aveeno. However, at Refresh Dermatology, Epionce is the favored moisturizer.
“Epionce uses natural botanical ingredients to most effectively rehydrate and heal skin,” Dr. Chilukuri said. “We also sometimes mix retinol with one of these 4 emollients for a greater enhancement of the overall thickness of the upper dermis.”
The combination therapy not only helps resolve the purpura more quickly, but also prevents some future bruises.
For Epionce extreme barrier cream, patients are instructed to mix in a pea-size drop of retinol before applying, once a day at night. Then in the morning, they apply either Epionce, CeraVe, Cetaphil, or Aveeno.
“With this protocol, patients will typically notice less bruising within about 8 to 12 weeks,” Dr. Chilukuri said.
For patients with extreme cases of bruising, Refresh Dermatology offers laser and light-based therapy that allows for rapid resolution of bruises.
Dr. Chilukuri’s laser of choice for purpura is a 595-nm pulse dye laser, with a 6-mm spot size, 7 msec and a pulse duration of 10 Hz.
One treatment session is sufficient for most patients. Some patients undergo a follow-up laser treatment 2 days later, with the exact same settings, followed immediately by combined radiofrequency (RF) and ultrasound (Exilis Ultra).
“These technologies improve blood flow and help remove extravasated red blood cells,” Dr. Chilukuri said.
A 650-microsecond 1064-nm Nd:YAG laser is also often used to treat purpura and ecchymoses. “I like this laser because it is safe in all skin types, whereas the pulse dye laser is mostly reserved for skin types I through III,” Dr. Chilukuri. Settings for the Nd:YAG laser are dependent on the patient’s skin type.
As with the pulse dye laser, patients schedule 1 or 2 sessions of the Nd:YAG laser, spaced about 2 days apart. “With 1 or 2 treatments, the bruise is gone within anywhere from 24 hours to 96 hours,” Dr. Chilukuri said.
For either laser, a treatment session lasts 3 to 4 minutes.
Broadband light is also part of the mix at Refresh Dermatology, consisting again of 1 or 2 sessions, spaced about 2 days apart.
“I believe we have some great choices to treat senile purpura,” Dr. Chilukuri said. “Once you get familiar with your light source, you can effectively enhance your patients’ results and experience.”
Disclosures
Dr. Chilukuri reports no relevant financial disclosures.
Commentary
Best outcomes for senile purpura
When treating senile purpura, it is important to promote moisture retention of the skin, according to Suneel Chilukuri, MD, the dermatologist at Refresh Dermatology in Houston, Texas. “Anything that rehydrates the skin and improves the water barrier will improve the overall health of the skin,” he said.
Three inexpensive, over-the-counter products that are quite effective for senile purpura are CeraVe, Cetaphil, and Aveeno. However, at Refresh Dermatology, Epionce is the favored moisturizer.
“Epionce uses natural botanical ingredients to most effectively rehydrate and heal skin,” Dr. Chilukuri said. “We also sometimes mix retinol with one of these 4 emollients for a greater enhancement of the overall thickness of the upper dermis.”
The combination therapy not only helps resolve the purpura more quickly, but also prevents some future bruises.
For Epionce extreme barrier cream, patients are instructed to mix in a pea-size drop of retinol before applying, once a day at night. Then in the morning, they apply either Epionce, CeraVe, Cetaphil, or Aveeno.
“With this protocol, patients will typically notice less bruising within about 8 to 12 weeks,” Dr. Chilukuri said.
For patients with extreme cases of bruising, Refresh Dermatology offers laser and light-based therapy that allows for rapid resolution of bruises.
Dr. Chilukuri’s laser of choice for purpura is a 595-nm pulse dye laser, with a 6-mm spot size, 7 msec and a pulse duration of 10 Hz.
One treatment session is sufficient for most patients. Some patients undergo a follow-up laser treatment 2 days later, with the exact same settings, followed immediately by combined radiofrequency (RF) and ultrasound (Exilis Ultra).
“These technologies improve blood flow and help remove extravasated red blood cells,” Dr. Chilukuri said.
A 650-microsecond 1064-nm Nd:YAG laser is also often used to treat purpura and ecchymoses. “I like this laser because it is safe in all skin types, whereas the pulse dye laser is mostly reserved for skin types I through III,” Dr. Chilukuri. Settings for the Nd:YAG laser are dependent on the patient’s skin type.
As with the pulse dye laser, patients schedule 1 or 2 sessions of the Nd:YAG laser, spaced about 2 days apart. “With 1 or 2 treatments, the bruise is gone within anywhere from 24 hours to 96 hours,” Dr. Chilukuri said.
For either laser, a treatment session lasts 3 to 4 minutes.
Broadband light is also part of the mix at Refresh Dermatology, consisting again of 1 or 2 sessions, spaced about 2 days apart.
“I believe we have some great choices to treat senile purpura,” Dr. Chilukuri said. “Once you get familiar with your light source, you can effectively enhance your patients’ results and experience.”
Disclosures
Dr. Chilukuri reports no relevant financial disclosures.
Commentary
Best outcomes for senile purpura
When treating senile purpura, it is important to promote moisture retention of the skin, according to Suneel Chilukuri, MD, the dermatologist at Refresh Dermatology in Houston, Texas. “Anything that rehydrates the skin and improves the water barrier will improve the overall health of the skin,” he said.
Three inexpensive, over-the-counter products that are quite effective for senile purpura are CeraVe, Cetaphil, and Aveeno. However, at Refresh Dermatology, Epionce is the favored moisturizer.
“Epionce uses natural botanical ingredients to most effectively rehydrate and heal skin,” Dr. Chilukuri said. “We also sometimes mix retinol with one of these 4 emollients for a greater enhancement of the overall thickness of the upper dermis.”
The combination therapy not only helps resolve the purpura more quickly, but also prevents some future bruises.
For Epionce extreme barrier cream, patients are instructed to mix in a pea-size drop of retinol before applying, once a day at night. Then in the morning, they apply either Epionce, CeraVe, Cetaphil, or Aveeno.
“With this protocol, patients will typically notice less bruising within about 8 to 12 weeks,” Dr. Chilukuri said.
For patients with extreme cases of bruising, Refresh Dermatology offers laser and light-based therapy that allows for rapid resolution of bruises.
Dr. Chilukuri’s laser of choice for purpura is a 595-nm pulse dye laser, with a 6-mm spot size, 7 msec and a pulse duration of 10 Hz.
One treatment session is sufficient for most patients. Some patients undergo a follow-up laser treatment 2 days later, with the exact same settings, followed immediately by combined radiofrequency (RF) and ultrasound (Exilis Ultra).
“These technologies improve blood flow and help remove extravasated red blood cells,” Dr. Chilukuri said.
A 650-microsecond 1064-nm Nd:YAG laser is also often used to treat purpura and ecchymoses. “I like this laser because it is safe in all skin types, whereas the pulse dye laser is mostly reserved for skin types I through III,” Dr. Chilukuri. Settings for the Nd:YAG laser are dependent on the patient’s skin type.
As with the pulse dye laser, patients schedule 1 or 2 sessions of the Nd:YAG laser, spaced about 2 days apart. “With 1 or 2 treatments, the bruise is gone within anywhere from 24 hours to 96 hours,” Dr. Chilukuri said.
For either laser, a treatment session lasts 3 to 4 minutes.
Broadband light is also part of the mix at Refresh Dermatology, consisting again of 1 or 2 sessions, spaced about 2 days apart.
“I believe we have some great choices to treat senile purpura,” Dr. Chilukuri said. “Once you get familiar with your light source, you can effectively enhance your patients’ results and experience.”
Disclosures
Dr. Chilukuri reports no relevant financial disclosures.