In short
- The solar lentigo —the flat brown mark on areas that have had years of sun— is the classic target of intense pulsed light.
- The diagnosis comes before the shot. In a series of eleven melanomas diagnosed on areas previously treated with laser, in nine of the eleven cases (82%) no histological examination had been done beforehand.
- A systematic review of 16 studies and 637 participants supports IPL for lentigines and hyperpigmentation, with a mean of 4.29 sessions (range 3 to 7).
- That same review sets two limits: there is no consensus on the settings and nine of the sixteen studies were of low methodological quality.
- A treated mark darkens first, forms a fine crust and falls off within a few days. That initial darkening is what should happen, not a worsening.
- Sun spots come back if the cause comes back. Without sustained sun protection, the result does not hold.
Intense pulsed light works well on sun spots because the pigment absorbs its light, breaks up and is eventually cleared. But before that sentence comes a more important one: not all brown marks are the same thing, and some are not treated until it is known what they are. Treating a pigmented lesion with light without diagnosing it can erase what is visible without resolving what lies beneath, and delay a diagnosis that matters.
This page explains how one kind of mark is told from another, what the evidence supports about IPL for lentigines, how a treated mark progresses and in what situations no shot is fired.
This page sets out the pigmentary indication for intense pulsed light. If your problem is redness and not brown colour, the page that applies to you is IPL for redness and rosacea.
Not all brown marks are the same thing
This is the part almost never explained and the one that decides whether intense pulsed light is the answer.
- Solar lentigo. Flat, uniformly brown, with well-defined edges, on areas of accumulated exposure: the face, the décolletage, the backs of the hands, the shoulders. It is the classic pigmentary indication for IPL.
- Freckle (ephelis). Smaller, lighter, it appears on fair skins and darkens with the sun and fades in winter. It responds to light, but it recurs easily.
- Seborrhoeic keratosis. Brown but raised and rough on the surface, not flat. It is not simply a mark of pigment: it is a lesion with relief, and its treatment is not the same.
- Melasma. Symmetrical patches with blurred edges, on the forehead, the cheekbones and the upper lip, strongly influenced by hormones, sun and heat. It is chronic and recurring, and its management is different: the evidence supports IPL only within a combined treatment, never as a stand-alone solution.
- The one that has to be investigated. Any mark that is asymmetrical, with irregular edges, of uneven colour, that grows, changes, itches or bleeds. Here no aesthetic conversation is possible until it is known what it is.
Why the diagnosis comes before the shot
This section exists because it is the most serious risk of the whole treatment and the one least often mentioned.
A piece of work published in 2017 reviewed eleven patients diagnosed with melanoma in an area previously treated with laser between 2007 and 2014. In nine of the eleven (82%) no histological examination had been carried out before the treatment. The time between the laser and the diagnosis ranged from less than a year to ten years; the stage at diagnosis ran from IA to IIIC; four patients progressed to stage IV and at least one died of the melanoma. The authors’ conclusion is blunt: laser treatment of pigmented lesions should be avoided or, at the very least, carried out only after prior histological examination.
A review aimed at family doctors adds the complementary practical criterion: a biopsy should be considered when the diagnosis is not clear or when repigmentation appears after light therapy, because the destruction of melanocytes can be incomplete and the treated area is harder to monitor afterwards.
Translated into what happens in the consulting room:
- A mark is looked at before it is treated, and if there is any doubt, it is investigated. The assessment of skin lesions is described in the assessment of skin lesions.
- A mark lightening with light does not mean it was benign. It means it has lightened.
- If a treated mark pigments again, the session is not repeated without assessing it again.
A centre that treats marks without looking at them —or where nobody with medical judgement looks at them— is taking on a risk that is not theirs but yours.
At ICPM the intense pulsed light treatment is given by the centre’s doctors or by a specialist technician. And if a lesion has to be investigated first, there is no need to go elsewhere: the assessment and removal of skin lesions, with pathological examination of the specimen, is carried out by the reconstructive team itself.
What the evidence supports
The reference systematic review on IPL in skin rejuvenation brought together 16 studies and 637 participants, with skin types I to IV and ages from 21 to 80. Among the outcomes described are lentigines and hyperpigmentation, along with telangiectasias, wrinkles, pore size, erythema and texture. The patients received a mean of 4.29 sessions, in a range of 3 to 7.
The authors themselves mark the limits, and they are worth repeating because they are what makes promising a figure impossible:
- There is no consensus on the settings.
- Nine of the sixteen studies were of low methodological quality.
That is: there is support for treating and there is none for guaranteeing a percentage of clearance or a fixed number of sessions. A sensible plan starts at three or four sessions several weeks apart and is reviewed according to the response.
How a treated mark progresses
Knowing this avoids the commonest fright of the first few days.
- Immediately afterwards, the mark usually looks darker than before. It is the expected response: the pigment has absorbed the energy.
- Over the following days a fine, dark crust forms over the lesion.
- It falls off on its own, generally within a week or a little more, taking the pigment with it. It is not picked off: picking it off is the usual way of leaving a mark where there was a spot.
- Underneath is lighter skin, which in the first few weeks may be somewhat pink.
On the treated area, sun protection stops being cosmetic advice and becomes the measure that prevents the inflammation itself from leaving new pigment.
When no shot is fired
- An undiagnosed pigmented lesion. It is first on the list for a reason.
- Tanned skin, recent sun exposure or exposure planned for the near future, or use of fake tan.
- Photosensitising drugs.
- Active infection in the area.
- Pregnancy, as a precaution and because of the pigmentary instability of that period.
- Melasma as the main diagnosis, except within a combined plan and with strict sun protection.
- An expectation of treating relief, texture or laxity: that is a different indication, and it is in the comparison between CO₂ and intense pulsed light.
They come back, and that is not a failure of the treatment
Sun spots are the trace of accumulated exposure. If the exposure carries on, the pigment is produced again. That means two honest things:
- The result is maintained with daily sun protection and, in many cases, with the odd maintenance session.
- A recurrence does not mean the treatment has failed, but it does mean the mark has to be looked at again, and all the more so if it reappears exactly where it was treated.
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Frequently asked questions
Does intense pulsed light remove sun spots?
It lightens them. The available evidence supports IPL for lentigines and hyperpigmentation, but without consensus on settings and with a good part of the studies of low methodological quality, so no specific percentage of clearance can be promised.
How many sessions will I need?
The reference systematic review records a mean of 4.29 sessions, in a range of 3 to 7. In consultation three or four are proposed and the response is reviewed.
The mark is darker after the session — is that normal?
In the first few days, yes: the pigment absorbs the energy, the mark darkens and forms a fine crust that falls off at around a week. If the area goes on darkening after that, seek advice.
Can I have a mole treated?
No, and this is the important answer on the whole page. A pigmented lesion is diagnosed first. There are published cases of melanomas diagnosed in areas previously treated with laser without prior histological examination.
Does it work for melasma?
Melasma is another matter. The evidence supports IPL within a combined treatment and with strict sun protection, not as a stand-alone solution, because it is a chronic, recurring condition.
Can I have it done in summer?
It is the worst time of year: tanned skin is a contraindication and the exposure afterwards compromises the result and increases the risk of pigmenting.
Do they come back?
They can come back if the cause comes back. They are kept at bay with daily sun protection and, in many cases, the odd maintenance session.
Does it hurt?
It is described as a brief snap or sting, like an elastic band. It is tolerable in most cases and does not require a general anaesthetic.
Sources
- Delker S, Livingstone E, Schimming T, Schadendorf D, Griewank KG. Melanoma diagnosed in lesions previously treated by laser therapy. J Dermatol. 2017;44(1):23-28. Eleven patients; in 9 of 11 (82%) no histological examination had been carried out before the laser; the authors recommend avoiding the treatment of pigmented lesions or carrying it out only after histological examination. https://pubmed.ncbi.nlm.nih.gov/27345456/
- Curry L, Cunningham N, Dhawan S. Cosmetic light therapies and the risks of atypical pigmented lesions. Can Fam Physician. 2021;67(6):433-435. A biopsy should be considered when the diagnosis is not clear or when there is repigmentation after light therapy. https://pubmed.ncbi.nlm.nih.gov/34127467/
- Sales AFS, Pandolfo IL, de Almeida Cruz M, et al. Intense Pulsed Light on skin rejuvenation: a systematic review. Arch Dermatol Res. 2022. Sixteen studies and 637 participants, skin types I-IV; a mean of 4.29 sessions (range 3-7); outcomes in lentigines and hyperpigmentation; no consensus on settings and nine studies of low methodological quality. https://pubmed.ncbi.nlm.nih.gov/34609598/
- Yi J, Hong T, Zeng H, et al. A Meta-analysis-Based Assessment of Intense Pulsed Light for Treatment of Melasma. Aesthetic Plast Surg. 2020. IPL reduces MASI within a combined treatment. https://pubmed.ncbi.nlm.nih.gov/32055937/
Book your consultation
If you have marks that come back every summer, the first thing is not to choose a technology: it is for someone to look at those marks and say what they are. At an assessment in person the lesions are examined, the skin type is determined and it is decided whether intense pulsed light, another technique or prior investigation is what applies.
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Last reviewed: 23 August 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
