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Literature Review
Long-Term Removal of Unwanted Hair Using Light
Abstract
Laser (or light) hair removal, also referred to as photoepilation, is the most commonly used laser or light-based cosmetic medical procedure. The extended theory of selective photothermolysis is the basic principle for destruction of hair follicles using light. In this type of laser application the chromophore is follicular melanin. Several types of lasers and light sources have been effective for hair reduction, including the ruby, alexandrite, diode, and neodymium:yttrium-aluminum-garnet lasers and broadband, intense pulsed light sources. This article provides a broad overview of how hair can be removed using light, with an emphasis on practical considerations.
- ... Many studies have been published that document the efficacy; however, studies determining long-term results greater than 12 months are rare. In order to evaluate the true effect of any intervention, the study period has to exceed the duration of a complete growth cycle of a follicle in the treated area varying from 4 to 12 months according to the body location [11][12][13], which optimally suggests a follow-up of greater than 12 months. ...... It is of note, that the assessment of clearance by patients rating was inferior to the rating of a physician at the same time point. As already suggested by many authors we think it is an important part of the consultation visit to establish realistic patient expectations, particularly the fact that laser treatment leads to a reduction of hair but not complete removal of all hairs in the treatment areas [11,13]. ...Background and objectives: Laser hair removal is the most common laser therapy and the third most commonly performed procedure with more than one million treatments in United States in 2016. This retrospective study was conducted to assess long-term efficacy and safety of the 755 nm laser for hair removal. Study design/materials and methods: Nearly, 3,606 laser treatments were performed with the long-pulsed 755 nm wavelength laser equipped with an epidermal cooling device between 1997 and 2005 and were followed till 2013. Standardized assessments were conducted by two treating physicians and patients at two follow-up intervals. At first follow-up, clearance was assessed by two physicians and clearance and satisfaction by patients. At the second follow-up, patients were assessed if hair clearance sustained compared with the first follow-up. Results: Nine hundred and forty-eight patients with Fitzpatrick skin types I-IV were treated with a total of 3,606 laser treatments in this study. The mean age at the beginning of the study was 35 years (±11), 95.1% of patients were female (n = 902) and 4.9% male (n = 46). Five hundred and seventy-four patients received a minimum of three treatments and an average of 5.31 (3-16) treatments on axilla, back, bikini, breast, abdomen, face, lower extremity, or upper extremity region. First, follow-up was conducted 3.9 (±1.5) years after the final laser treatment. Seventy-four percent of these patients received 75-100% clearance as reported by the physician and 48% clearance as reported by the patient. Fifty-two percent of patients reported slower hair growth and 42% change in hair texture. Ninety percent of patients treated on axilla, 82% treated on the bikini area, and 79% treated on lower extremities experienced 75% or more clearance after three treatments. Facial, as well as breast and abdomen treatments, only showed a 66% and 62%, respectively, after three treatments. For these locations, five and more treatments were needed to achieve a quote of 79% (face) or 80% (breast and abdomen) for a 75-100% clearance. Upper extremity and back treatments did not have enough physician ratings to draw conclusions. Long-term adverse events were minimal and were all located on the face (one patient scar, four patients herpes infection). Second follow-up of 173 patients was conducted after 11.5 years (±2.0) and 87.9% of patients reported that their improvement sustained. Conclusions: The long-pulsed 755 nm alexandrite laser is a safe and efficacious treatment for the reduction of unwanted body hair with permanent results and high patient satisfaction. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
- ... Con cada tratamiento se aprecia una disminución progresiva del número de pelos y su ritmo de crecimiento. 34,37 . ...... No debe olvidarse el uso de sistemas de enfriamiento por contacto para minimizar el daño térmico causado por la absorción lumínica de la melanina epidérmica. Se alcanzará un buen punto final si se observa la franca destrucción o aclaramiento del pelo, eritema perilesional, o edema perifolicular 6,21,32,34,38 . ...Los equipos de Luz Intensa Pulsada (IPL por sus siglas en inglés) representan en la actualidad una herramienta esencial en el arsenal terapéutico del dermatólogo. Las características físicas de la luz que emiten permiten su aplicación para el tratamiento efectivo no solo de alteraciones estéticas sino de diversas patologías frecuentes en la consulta dermatológica. Los usos terapéuticos más frecuentes de esta tecnología incluyen el tratamiento de lesiones vasculares, lesiones pigmentadas, fotodepilación, rosácea, acné, fotoenvejecimiento, cicatrices, estrías; también se utiliza como fuente de luz en tratamientos con terapia fotodinámica (TFD). Más aún, existen algunos reportes de su uso en poroqueratosis, quistes pilonidales y queratosis seborreicas, entre otros. En esta revisión conoceremos las características físicas de la luz emitida por estos equipos, sus efectos en la piel, los principios básicos de su uso, las patologías en las que puede utilizarse, los protocolos generales de tratamiento, y se darán recomendaciones actuales para el uso óptimo y seguro de esta tecnología con base en las publicaciones actuales y en la experiencia de la autora. INTENSE PULSED LIGHT,: concepts and current uses Summary Nowadays, Intense Pulsed Light (IPL) devices represent an essential therapeutic tool for dermatologists. The physical properties of this light allow its use not just for esthetic purposes, but also for an effective treatment of several dermatological conditions. Clinical uses of this technology include treatment of vascular lesions, pigmented lesions, photodepilation, rosacea, acne, photoaging, scars, striae. Also, it is used as light source in photodynamic therapy, as well as in other pathologies like porokeratosis, pilonidal cysts, and seborrheic keratosis, and others. This review will show the physical characteristics of the light emitted by these devices, the effects on the skin, the fundamentals of its use, indications, general protocols, and will provide recommendations for the optimal and safe use of this technology based on updated scientific publications, and the author’s experience
- ... Intense Pulse Light (IPL) emits polychromatic non-coherent light with wave-lengths from 400-1400 nm. For hair removal a filter that filters the wave-lengths below 525-550 nm is often used [59]. ...... Other studies have found lasers and IPL equally effective [59,73]. A prospective randomized intrapatient, right-left assessor-blinded study compared Nd:YAG vs IPL for hair removal. ...Hirsutism, excessive hair growth in women in a male pattern distribution, is the most common endocrine disorder in women and approximately 5 to 15% of the general population of women is reported to be hirsute. It causes profound stress in women. Polycystic ovary syndrome is the most common cause. However a woman could have normal menses, normal androgen levels but be hirsute (idiopathic hirsutism). Ferriman- Gallwey scale (F-G) is used for assessment of hairiness. The maximum score is 36 and a score over 8 is considered as a hirsuid state. As hirsutism is a symptom and not a disease it is important to find the underlying cause and exclude uncommon but serious causes. The aim of the medical treatment is to correct the hormonal imbalance and thereby stop further progress. Oral contraceptives (OCP) are recommended as first line treatment. Spironolactone is the first choice if there is indication for antiandrogen therapy. Antiandrogens should be combined with an OCP in women in child bearing age as antiandrogens are teratogenic. Photo-epilation or electrolysis is mostly needed in order to reduce the amount of hair. Multiple treatments are needed. Hair reduction with each session with photo-epilation is estimated to 15% to 30%. Medical therapy and laser or IPL should be combined for best result.
- ... IPL emits polychromatic non-coherent light with wavelengths from 400-1400nm. For hair removal a filter that filters the wave-lengths below 525-550nm is often used [92]. If an IPL is used for hair removal it should have a dual filter system, i.e. also a water filter that filters wave length above 900nm in order to protect the skin from being burned (Figure 2,3). ...... Alexandrite and diode are said to be slightly more efficacious in some studies but not to the point of statistical significance [73]. In studies lasers and IPL have been found equally effective [92,93]. A prospective randomized intrapatient, right-left assessor-blinded study compared Nd:YAG vs IPL for hair removal on the leg in 38 patients. ...Hirsutism, excessive hair growth in women in a male pattern distribution, is an international issue and approximately 5 to 15% of the general population of women is reported to be hirsute. It causes profound stress in women. As hirsutism is a symptom and not a disease it is important to find the underlying cause. Polycystic ovary syndrome is the most common cause but other not so common endocrinology disorders must be excluded. Mild hirsutism could be seen in a woman with normal menses and normal androgen levels (idiopathic hirsutism). Ferriman-Gallwey scale (F-G) is used for assessment of hairiness. The maximum score is 36 and a score over 8 is considered as a hirsuid state. The aim of the medical treatment is to correct the hormonal imbalance and stop further progress. Oral contraceptives (OCP) are recommended as first line treatment. Spironolactone is the first choice if there is indication for antiandrogen therapy. Antiandrogens should be combined with an OCP as antiandrogens are teratogenic. Photo-epilation or electrolysis is mostly needed in order to reduce the amount of hair. Multiple treatments are required. Hair reduction with each session with photo-epilation is estimated to 15% to 30%. Medical therapy and laser or IPL should be combined for best result.
- ... IPL therapy is a non-invasive light-based technique that utilizes light in the wavelength range of 500 nm to 1200 nm to target the chromophores hemoglobin and melanin [9] . IPL has been successfully utilized to treat vascular and pigmented lesions of the oculofacial area [9] , and may be used for hair removal [10] and photorejuvenation [11] as well. It is currently an FDA approved therapy for the treatment of photoaging. ...... Goldberg et al [11] have shown that IPL for photorejuvenation spares the epidermis and targets the dermis, generating collagen, and enabling skin tightening and contraction. Zandi et al [10] investigated the use of IPL for hair removal and proved that it is limited to pigmented follicles, as the target chromophore is melanin. The target chromophores for IPL also restrict its use primarily to patients of lighter skin types. ...Demand for non-invasive techniques to treat oculofacial pathology has allowed for the growth and development of several new laser and light therapy modalities. These modalities include the use of intense pulsed light (IPL) and photodynamic therapy (PDT), light-emitting diode devices, as well as ablative and non-ablative lasers. Therapeutic applications in the periorbital area may involve the treatment of vascular lesions, telangiectasias, dyspigmentation, photodamage, hypertrichosis, rhytids, and scars. Laser and light-based technology offers patients treatment options that range from conservative to aggressive, allowing for choices between subtle results with little downtime or dramatic results with longer downtime. Advantages of laser treatments, as compared to traditional medical and surgical treatments, include a longer lasting effect than some of the conservative therapies and the ability to serve as a happy medium between non-invasive topical medicine and invasive surgical techniques. For patients seeking non-invasive alternatives, these modalities confer a major advantage over incisional surgery. Understanding appropriate usage, side effects, and outcomes is before treating functional and cosmetic issues. Here we present a review of current treatment modalities, their use, side effects, and outcomes. Key Words: Intense pulsed light, Ablative lasers, Non-ablative lasers, Fractional lasers, Photodynamic therapy, Non-invasive techniques Core tip: Laser and light treatments have become an essential addition in the oculoplastic service armamentarium for the management of different pathological oculofacial conditions as well as for aesthetic improvement. Both the unique anatomy of the periocular area, and one’s individual treatment goals for the patient, must help tailor the choice of laser, the energy level used, and the depth of treatment to achieve an optimum result. Citation: Portaliou DM, Liao SD, Shields RA, Lee WW. Review of laser and light therapy in the treatment of oculofacial pathology. World J Ophthalmol 2014; 4(2): 14-20
- ... In these experiments, extreme heating was not desired as continuous exposure of the skin to high temperatures (>48 °C) has been a factor for hair loss 46 . Thermolysis destroys the HF cells and is, in fact, an approach used in laser photoepilation, aiming to remove unwanted hair 47 . In order to avoid damage to the HF and body thermoregulatory responses (above 40 °C) as infiltration of inflammatory cells in the skin 48 , the heating protocol should be restricted to 40 °C. ...Clobetasol propionate (CLO) is a potent glucocorticoid used to treat inflammation-based skin, scalp, and hair disorders. In such conditions, hair follicles (HF) are not only the target site but can also act as drug reservoirs when certain formulations are topically applied. Recently, we have demonstrated nanostructured lipid carriers (NLC) containing CLO presenting epidermal-targeting potential. Here, the focus was evaluating the HF uptake provided by such nanoparticles in comparison to a commercial cream and investigating the influence of different physical stimuli [i.e., infrared (IR) irradiation (with and without metallic nanoparticles-MNP), ultrasound (US) (with and without vibration) and mechanical massage] on their follicular targeting potential. Nanosystems presented sizes around 180 nm (PdI < 0.2) and negative zeta potential. The formulation did not alter skin water loss measurements and was stable for at least 30 days at 5 °C. Nanoparticles released the drug in a sustained fashion for more than 3 days and increased passively about 40 times CLO follicular uptake compared to the commercial cream. Confocal images confirmed the enhanced follicular delivery. On the one hand, NLC application followed by IR for heat generation showed no benefit in terms of HF targeting even at higher temperatures generated by metallic nanoparticle heating. On the other hand, upon US treatment, CLO retention was significantly increased in deeper skin layers. The addition of mechanical vibration to the US treatment led to higher follicular accumulation compared to passive exposure to NLC without stimuli. However, from all evaluated stimuli, manual massage presented the highest follicular targeting potential, driving more than double the amount of CLO into the HF than NLC passive application. In conclusion, NLC showed great potential for delivering CLO to HF, and a simple massage was capable of doubling follicular retention.
- ... Permanent hair removal may be achieved with electrolysis, lasers, or intense pulsed light devices. Each of these methods has been successfully used to remove facial hair in women and men; however, multiple treatments are usually necessary [19][20]. Indeed, investigators recently reported successful laser removal of hair growth after six treatments on the scrotal skin of an individual prior to vaginoplasty for male-to-female gender reassignment using a long-pulsed 755-nanometer alexandrite laser at the following parameters: fluences of 18 to 30 Joules per square centimeter, pulse duration of 10 to 20 milliseconds, and spot size of 12 millimeters [21]. ...Genital rejuvenation is applicable not only to women (vaginal rejuvenation) but also to men (scrotal rejuvenation). There is an increased awareness, reflected by the number of published medical papers, of vaginal rejuvenation; however, rejuvenation of the scrotum has not received similar attention in the medical literature. Scrotal rejuvenation includes treatment of hair-associated scrotal changes (alopecia and hypertrichosis), morphology-associated scrotal changes (wrinkling and laxity), and vascular-associated scrotal changes (angiokeratomas). Rejuvenation of the scrotum potentially may utilize medical therapy, such as topical minoxidil and oral finasteride, for scrotal alopecia and conservative modalities, such as depilatories and electrolysis, for scrotal hypertrichosis. Lasers and energy-based devices may be efficacious for scrotal hypertrichosis and scrotal angiokeratomas. Surgical intervention is the mainstay of therapy for scrotal laxity; however, absorbable suspension sutures are postulated as a potential intervention to provide an adequate scrotal lift. Hair transplantation for scrotal alopecia and injection of botulinum toxin into the dartos muscle for scrotal wrinkling are hypothesized as possible treatments for these conditions. The interest in scrotal rejuvenation is likely to increase as men and their physicians become aware of both the conditions of the scrotum that may warrant rejuvenation and the potential treatments of the scrotum for these individuals.
- ... Until the 1990s, electrolysis was the only method available for 'perma- nent' depilation. After advances in laser technology and indications in the 1990s, laser depilation became widespread 2,3) . On the other hand depilation devices based on polychromatic and noncoherent broad-band intense pulsed light, with appropriate cut-off filters, were also reported, and found use in aesthetic salons. ...Background and Aims: Laser hair removal has recently become a major indication. Diode lasers have become commercially available offering two modes of application: a stamping or static mode, and a dynamic mode whereby the handpiece is continuously moved across the target tissue. The present study was designed to compare the efficacy of these two approaches clinically and histologically. Subjects and Methods: Twenty-five subjects participated in the study, 12 males and 13 females, ages ranging from 20 to 57 yr (Mean age 41.6 yr). A baseline hair count was performed on both the target areas. The ms-pulsed diode laser delivered 810 nm via a handpiece with a cooled tip, offering both static and dynamic modes which were used on the subjects’ left and right crura, respectively. Pain during treatment was assessed using a visual analog scale (VAS) and gross inspection was performed immediately after treatment for any abnormality in the treated skin. Hair counts were performed on both crura at 1 and 3 months after the treatment, and compared with the baseline counts. Biopsies were performed in the dynamic mode treated skin at baseline and at 1 month after the treatment, and assessed with light microscopy, immunohistochemistry and transmission electron microscopy (TEM). Results: All subjects completed the study. Compared with baseline, hair counts were significantly lower at 1 and 3 months post-treatment with no significant difference between the static and dynamic laser depilation modes, nor in the severity of the pain experienced during the procedure. Histologically, degenerative changes in the hair follicles were noted immediately after laser treatment. At one month, cystic formation was seen in the hair follicles showing a strong tendency towards apoptotic cell death. Conclusions: With the diode laser system and at the parameters used in the present study, high depilation efficacy was seen with no significant difference between the static and dynamic modes. Interestingly, good long-term depilation is probably a result of induced apoptotic cell death in the follicles rather than any other mechanism.
- ... Cuatro quintas partes de las mujeres que han removido alguna vez su vello genital prefieren hacerlo con máquina y crema de afeitar, una cuarta parte lo re cortan con tijeras y una sexta parte han recurrido a las crema depilatorias o a las bandas de cera (2,56). Sin embargo, pareciera que hay un incremento en la frecuencia de uso de procedimientos definitivos tipo láser (16,19,41). ...Objective: To show that female pubic hair shaving, a common current practice, is the result of changing trends in dress and fashion, and of the marketing strategies of the manufacturers of hair removal devices; and to consider what women today argue as their reasons for this practice. Materials and methods: The historical background for pubic hair removal is presented, including the approach in other cultures, the frequency and the reasons for this practice at present; the marketing and communication strategies are reviewed. Conclusions: The current female beauty imagery in this early part of the 21st century involves the search for an ideal of smooth hair-free skin which is only achievable through artificial means, leading society as a whole to consider it the standard for cosmetic, hygienic, erotic and self-image reasons.
- ... It was reported that, by this method which is based on the use of selective photothermolysis, the melanin pigment within the hair follicle is targeted without giving any damage to the surrounding tissue. [1] Conversion of laser to thermal energy at the hair follicle that absorbs laser causes thermal damage to the hair follicle. [2] New applications that are implemented to our daily lives with the technological developments remind us the possibility of mutations in human beings that can be caused by the new application. ...Background: Laser epilation is a method of removal of unwanted hair from the body and its use for this cosmetic purpose is gaining increasing popularity. Sister chromatid exchange (SCE) is a critical method for determining genotoxicity caused by several mutagens and carcinogens under in vivo and in vitro conditions. Aims & Objective: In this study, we aimed to determine whether removal of unwanted hair by laser epilation causes genotoxicity in women undergoing this procedure. Materials and Methods: 40 voluntary women who admitted to the dermatology clinics for the removal of unwanted hair by laser epilation were included. Skin types of all patients were classified according to Fitzpatrick Scale. Laser epilation was applied by Alexandrite (Light Age Epicare Duo) at a 755 nm wavelength laser. The possible genotoxic effects in women who had laser epilation to the whole leg (upper and lower leg) and face was investigated by the SCE method. Results: The blood samples that were drawn before and 24 hours after the laser application showed no significant differences between the SCE frequencies (p>0.05). Conclusion: We could not find any significant genotoxic effect of laser epilation in women undergoing this procedure. As far as we know, this is the first study that investigates the relationship between laser applications and genotoxic effects.
- Laser spielen in der plastischen Kinderchirurgie und Dermatologie eine wichtige Rolle. Während die ersten Lasersysteme zur unspezifischen Gewebeablation verwendet wurden, stehen heute verschiedene Geräte zur Verfügung, welche eine spezifische Behandlung einzelner Gewebekomponenten bei gleichzeitig Schonung der Umgebung erlauben (selektive Photothermolyse). Laser werden bei Kindern vor allem zur Behandlung von Gefäßanomalien, Pigmentierungsstörungen sowie Narben verwendet, seltener auch zur Enthaarung. Dieses Kapitel soll eine praktisch orientierte Übersicht über physikalische Grundlagen von Lasern, spezifische Aspekte in der Laserbehandlung von Kindern sowie die Behandlung häufiger Krankheitsbilder geben.
- Background: Photoepilation is the treatment of choice for hair removal in patients with hirsutism, but it remains a challenge to prevent regrowth of hairs. Objectives: The objective of this study was to investigate whether topical eflornithine maintains hair reduction in hirsute patients after cessation of intense pulsed light (IPL) therapy. Methods: A randomized, split-face, single-blinded controlled trial on topical eflornithine vs. no eflornithine treatment (control) after 5-6 IPL-treatments in 22 women with facial hirsutism. Application of eflornithine was initiated after the final IPL-treatment (baseline) and applied twice daily for 6 months to half of the face. Patients were assessed at baseline and 1, 3 and 6 months after the final IPL-treatment. The primary endpoint was difference in facial hair counts between eflornithine vs. no treatment. Secondary endpoints were patient-evaluated efficacy, patient satisfaction and safety. Results: A total of 18 patients completed the study protocol. At 1 month after final IPL-treatment, eflornithine reduced hair regrowth by 14% (P = 0.007, n = 20 patients), at 3 months by 9% (P = 0.107, n = 19) and at 6 months by 17% (P = 0.048, n = 18) compared to no treatment. Patient-evaluated efficacy supported blinded hair counts and patients were satisfied with eflornithine treatment throughout the study (median VAS 5-6). Eflornithine was generally well tolerated, but blinded evaluation demonstrated deterioration of acne in two patients at final assessment. Conclusion: Topical eflornithine provides a self-administered treatment with a potential to maintain IPL-induced hair reduction in hirsute patients.
- Ocular tissues are known to be sensitive to damage from exposure to laser emissions. This study reports the case of a female patient with acute unilateral anterior uveitis caused by alexandrite laser-assisted hair removal of the eyebrows. We report a 38-year-old female who presented with unilateral eye pain, redness, and photophobia after receiving alexandrite (755 nm) laser epilation of both eyebrows. Best corrected visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection and 2+/3+ cells in the anterior chamber. Intraocular pressure and fundus examination were normal. Topical steroids and cycloplegic drops were prescribed for 3 weeks. At the end of the 3-week follow-up, best corrected visual acuity was 20/20, and intraocular pressure and fundus examination were normal in both eyes. The left eye was white, and the anterior chamber was clear. The patient continues to be monitored. In conclusion, without adequate protective eyewear, laser hair removal of the eyebrows with alexandrite laser can lead to ocular damage.
- Although the loss of scalp hair is distressing and many medical treatments focus on its restoration, the removal of body hair has been adopted since ancient times. Beauty standards, which r eflect the culture of each society, have been presenting the depilated body as absolutely desirable. Through the ages various methods of hair removal have been used depending on the requirements of the individuals. In recent years, Laser and Intense Pulse Light devices have been considered as the most promising solution for excess hair growth, without excluding the efficacy of other methods to induce satisfactory epilatory results. The enzyme-based hair removal method has received little recognition even though experimental and clinical data support its efficacy to provide long term or even permanent epilation. The present review presents these data and examines the likelihood of considering the aforementioned method as ideal.
- Objetivo: demostrar que la remoción del vello púbico femenino –una práctica común en la actualidad– es el resultado de los cambios en el vestido y las estrategias de mercadeo de los fabricantes de productos para la remoción del vello y hacer una aproximación a lo que dicen las mujeres hoy en términos de las razones para hacerlo. Materiales y métodos: se presentan los antecedentes históricos de la remoción del vello genital, su manejo en otras culturas, la frecuencia y las razones por las que se hace en la actualidad, y se revisan las estrategias comerciales y de comunicación utilizadas desde el fin del siglo XIX en la cultura occidental. Conclusiones: el imaginario actual de belleza femenina de inicio del siglo XXI implica la modificación del cuerpo en la búsqueda de un ideal de piel tersa y libre de vello, solo posible de manera artificial, haciendo que la sociedad como un todo lo considere normativo por razones estéticas, higiénicas, eróticas y de autoimagen. Palabras clave: vello púbico, imagen corporal, rasurado genital, remoción del vello corporal, depilación, feminidad. ABSTRACT Objective: To show that female pubic hair removal, a common current practice, is the result of changing trends in dress and fashion, and of the marketing strategies of the manufacturers of hair removal devices; and to consider what women today argue as their reasons for this practice. Materials and methods: The historical background for pubic hair removal is presented, including the approach in other cultures, the frequency and the reasons for this practice at present; the marketing and communication strategies used since the end of the 19th in the western culture are reviewed. Conclusions: The current female beauty imagery in this early part of the 21st century involves the search for an ideal of smooth hair-free skin which is only achievable through artificial means, leading society as a whole to consider it the standard for cosmetic, hygienic, erotic and self-image reasons.
Literature Review
- Hirsutism affects 5‐10% of unselected women, depending on ethnicity and definition. The past two decades have seen the development of lasers for the removal of unwanted hair, using selective destruction of the hair follicle without damage to adjacent tissues. Selective photothermolysis relies on the absorption of a brief radiation pulse by specific pigmented targets, which generates and confines the heat to that selected target. In general, laser hair removal is most successful in patients with lighter skin colours and dark coloured hairs. Some studies have documented the results of laser hair removal in a controlled setting, although few have extended their observations beyond 1 year. In general, treatment with the ruby, alexandrite or diode lasers, or the use of intense pulsed light results in similar success rates, although these are somewhat lower for the neodymium:Yttrium‐Aluminum‐Garnet (nd:YAG) laser. Overall, laser hair removal should not be considered ‘permanent’, at least when considering the current data available. Repeated therapies are necessary, although complete alopoecia is rarely achieved and it is unclear at what point the maximum benefit is achieved from multiple therapies. While larger prospective, controlled, blinded and uniform studies are still needed, laser hair removal appears to be a useful adjuvant in the treatment of the hirsute patient.
- Objective: To determine the most effective treatment parameters for laser-assisted hair removal using a Q-switched neodymium:yttrium-aluminum-garnet (Nd: YAG) laser. Design: Prospective study to determine the effectiveness of Q-switched Nd:YAG laser—assisted hair removal under varying pretreatment protocols. Hair growth was assessed after laser treatment, and the results were compared with those of wax epilation at 4, 12, and 24 weeks. Setting: A private ambulatory laser facility and academic referral center. Intervention: Laser-assisted hair removal was performed under 4 different pretreatment conditions. Eighteen areas of unwanted body and facial hair from 12 study subjects were divided into 4 quadrants. Wax epilation followed by application of a carbon-based solution and exposure to Q-switched Nd:YAG laser radiation was performed on 1 quadrant. A second quadrant was wax epilated and exposed to Q-switched Nd:YAG laser radiation without prior carbon solution application. A third quadrant was exposed to laser radiation alone, and a final quadrant was wax epilated to serve as the control. Follow-up evaluations at 1, 3, and 6 months consisted of photographic documentation, manual hair counts, and patient hair-density estimates. Main Outcome Measure: Percentage of hair regrowth as assessed by objective hair counts and patient subjective evaluations. Results: Mean percentage of hair regrowth at 1 month was 39.9% for the wax-carbon-laser quadrant, 46.7% for the wax-laser quadrant, 66.1% for the laser-alone quadrant, and 77.9% for the wax control quadrant. The percentage of hair regrowth approximately doubled by 3 months but was significantly delayed in all laser-treated quadrants regardless of pretreatment protocol. Full hair regrowth in all anatomic locations was observed by month 6. Patient subjective evaluations of hair density closely approximated hair count data. No adverse effects or long-term complications were observed. Conclusions: A single hair-removal treatment with the Q-switched Nd:YAG laser is safe and effective in delaying hair growth for up to 3 months. Although the combination of pretreatment wax epilation and topical carbon solution application was effective, laser irradiation alone, with or without wax epilation, also provided a significant delay in hair growth.Arch Dermatol. 1997;133:1546-1549
- Background and Objectives The aim was to study hair removal efficacy, and possible side effects of two commercially available long pulsed diode lasers. The radiant exposure was selected to a value of 35 J/cm2, which is frequently used in the clinic in accordance with manufacturer's recommendations.Study Design/Materials and MethodsA prospective clinical study was performed on twenty-nine patients with hair color ranging from light brown to black on the upper lip. One half of the upper lip was randomly selected for treatment with the MedioStar® laser; the contralateral half of the lip was treated with the LightSheer® laser. Three treatments were performed at 6–8 week intervals. Percent hair reduction and acute- and long-term side effects were evaluated after treatment.ResultsThe average hair reductions 6 months after the first treatment were 49% with the MedioStar® laser and 48% with the LightSheer® laser. No scarring or pigmentary change of the skin was observed after any of the treatments with either laser. However, differences in acute side effects such as degree of erythema and burned hairs were observed.Conclusions No statistically significant differences in hair removal efficacy were observed. These results agree with mathematical modeling, which also offers a method to estimate hair removal efficacy and adverse effects for a range of hair characteristics and laser parameters. Lasers Surg. Med. 32:399–404, 2003. © 2003 Wiley-Liss, Inc.
- Background. Different techniques have been used for hair removal. Electrolytic epilation is a widely accepted method for this purpose. Recently laser hair removal was introduced.Objective. To evaluate and compare the effectiveness of long-pulse alexandrite laser hair removal with electrolytic epilation.Methods. Twenty-four areas of unwanted axillar hair in 12 patients were included in the study. The right axillar area of the patients was treated by electrolysis with an intensity of 4–8 mA, and the left area was treated with long-pulse alexandrite laser with fluences between 30 and 50 J/cm2. Electrolysis was performed four times at 3-week intervals, and laser treatment was performed three times at 4-week intervals. Before each session, the hairs in a 4 cm2 area centered in the axilla were counted. The last evaluation was done 6 months after the initial treatment. The pain, time, and cost of each procedure are compared.Results. The average clearance rate of the hairs was 74% by laser and 35% by electrolysis 6 months after the initial treatment.Conclusion. Alexandrite laser hair removal is a more reliable and practical solution than electrolysis. Laser hair removal is more expensive than electrolysis, but is 60 times faster and less painful than electrolysis; also fewer sessions are needed with the laser with better results.
- Background: Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. Advances in laser technology over the past several years has led to the development and distribution of numerous red and infrared lasers and light sources to address this issue. Despite the impressive clinical results that have been reported with the use of individual laser hair removal systems, long-term comparative studies have been scarce. Objective: To compare the clinical and histologic efficacy, side effect profile, and long-term hair reduction of long-pulsed diode and long-pulsed alexandrite laser systems. Methods: Twenty women with Fitzpatrick skin types I-IV and dark terminal hair underwent three monthly laser-assisted hair removal sessions with a long-pulsed alexandrite laser (755 nm, 2-msec pulse, 10 mm spot) and a long-pulsed diode laser (800 nm, 12.5 msec or 25 msec, 9 mm spot). Axillary areas were randomly assigned to receive treatment using each laser system at either 25 J/cm2 or 40 J/cm2. Follow-up manual hair counts and photographs of each area were obtained at each of the three treatment visits and at 1, 3, and 6 months after the final laser session. Histologic specimens were obtained at baseline, immediately after the initial laser treatment, and 1 and 6 months after the third treatment session. Results: After each laser treatment, hair counts were successively reduced and few patients found it necessary to shave the sparsely regrown hair. Optimal clinical response was achieved 1 month after the second laser treatment, regardless of the laser system or fluence used. Six months after the third and final treatment, prolonged clinical hair reduction was observed with no significant differences between the laser systems and fluences used. Histologic tissue changes supported the clinical responses observed with evidence of initial follicular injury followed by slow follicular regeneration. Side effects, including treatment pain and vesiculation, were rare after treatment with either laser system, but were observed more frequently with the long-pulsed diode system at the higher fluence of 40 J/cm2. Conclusion: Equivalent clinical and histologic responses were observed using a long-pulsed alexandrite and a long-pulsed diode laser for hair removal with minimal adverse sequelae. While long-term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical within 6 months, suggesting the need for additional treatments to improve the rate of permanent hair removal.
- Laser epilation is the most common dermatologic light-based procedure in the world. We describe a unique side effect of the procedure: a delayed persistent urticarial rash. We conducted a retrospective study involving 13,284 patients who received laser epilation at our clinics from January 2006 through March 2010 with 755 nm alexandrite laser (MiniGentleLase, Gentlelase, and GentleMax, Candela). Using patient clinical data and photos that were recorded on a standard side-effect report chart, we identified patients with suspected urticaria. Those patients were then followed for a period that ranged from 12 to 63 months. Only patients who could be diagnosed, treated, and followed by the dermatologist at our clinics were included in the study. Patients diagnosed or treated by other physicians or nurses and those without clinical photos or insufficient follow-up data were not included. We identified 36 patients who developed a severe, itchy, persistent hive rash on the treated area 6-72 hours after treatment. Eruption occurred most often on the legs (31 cases), followed by the groin (11 cases), axillae (eight cases), forearms (one case), and upper lip (one case). The eruption consisted of a hive rash with multiple pruritic perifollicular papules and confluent plaques on the treated area. Most patients required oral corticosteroids to control the symptoms. Lesions resolved in 7-30 days. The urticaria occurred mostly after the first treatment (26 cases), and was recurrent in subsequent treatments. Pretreating with oral corticosteroids prevented or limited the eruption. Thirty-three of the 36 patients reported a history of allergic rhinitis or some other allergy. Skin biopsies on four patients showed edema and a deep, dense dermal infiltrate consistent with lymphocytes mixed with eosinophils in a perivascular and occasionally perifollicular pattern in the mid and lower dermis. Persistent urticaria is a rare side effect of laser epilation. Rupture of the hair follicle by laser heat may trigger a delayed hypersensitivity reaction in a subset of predisposed allergic patients. An antigen from the disrupted hair follicle may be the triggering factor. To prevent this side effect, we recommend that laser epilation in allergic patients be preceded by an extended laser patch test, which should be evaluated 24-48 hours later. Preventive prednisone should be prescribed to patients who develop an urticarial rash on the test area.
- Light-based hair removal (LHR) is one of the fastest growing, nonsurgical aesthetic cosmetic procedures in the United States and Europe. A variety of light sources including lasers, e.g. alexandrite laser (755 nm), pulsed diode lasers (800, 810 nm), Nd:YAG laser (1064 nm) and broad-spectrum intense pulsed light (IPL, 590-1200 nm), are available and used widely for such procedures in dermatological/clinical settings under proper supervision. Patient selection and appropriate fluence settings are managed by professionals to maximize efficacy while minimizing adverse events. In the past 5 years, LHR devices have been sold directly to consumers for treatment in the home. In this review, we outline the principles underlying laser and IPL technologies and undertake an evidence-based assessment of the short- and long-term efficacy of the different devices available to the practising dermatologist and discuss the efficacy and human safety implications of home-use devices.
- Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction.
- This study was designed to evaluate the hypothesis that low-level fluences done repetitively on a hair follicle will produce permanent hair removal with less discomfort and fewer side effects than a single high-fluence pulse. To compare the safety and efficacy of a low-fluence, high-repetition rate versus a high-fluence, low-repetition rate 810-nm diode laser for permanent hair reduction in patients with facial hirsutism. Forty-two female patients with confirmed polycystic ovaries by ultrasonography with facial hirsutism were subjected to the low-fluence, high-repetition Soprano® XL laser in SHR mode and the LightSheer™ laser on each side of the face using preset parameters once a month for six sessions. Hair counts were done at the end of the sixth session using a 'Hi Quality Hair Analysis Program System' and the pain score was recorded by a visual analog scale. The overall median reduction of hair was 90.5% with the Soprano XL and 85% with the LightSheer, with a standard deviation of 7 and 8.5 respectively. This new technology, with low fluence and high repetition, showed a statistically insignificant increase in hair reduction compared to the LightSheer, but did show a significant reduction in hair thickness and a low pain score.
- Fox-Fordyce disease (FFD) is a relatively rare entity with a typical clinical presentation. Numerous studies have described unifying histopathological features of FFD, which together suggest a defect in the follicular infundibulum resulting in follicular dilation with keratin plugging, subsequent apocrine duct obstruction, and apocrine gland dilation, with eventual extravasation of the apocrine secretions as the primary histopathogenic events in the evolution of the disease. We describe a case of FFD that developed in a 41-year-old woman 3 months after completing a series of axillary laser hair removal treatments, and we detail the clinical and histopathological changes typical for FFD. Because defective infundibular maturation has been suggested to play a central role in the evolution of FFD, the close temporal relationship of laser hair therapy with the development of FFD suggests a causal role, which we continue to explore.
- The extended theory of selective photothermolysis enables the laser surgeon to target and destroy hair follicles, thereby leading to hair removal. Today, laser hair removal (LHR) is the most commonly requested cosmetic procedure in the world and is routinely performed by dermatologists, other physicians, and non-physician personnel with variable efficacy. The ideal candidate for LHR is fair skinned with dark terminal hair; however, LHR can today be successfully performed in all skin types. Knowledge of hair follicle anatomy and physiology, proper patient selection and preoperative preparation, principles of laser safety, familiarity with the various laser/light devices, and a thorough understanding of laser-tissue interactions are vital to optimizing treatment efficacy while minimizing complications and side effects.
- Laser hair removal is the most popular laser procedure in the United States (U.S.), yet there has not been a prospective study demonstrating long-term efficacy of diode laser hair removal beyond six months. A prospective, single-center, bilaterally paired, blinded, randomized comparison split leg study was carried out with 22 patients comparing high-fluence, single-pass diode laser to low-fluence, multiple-pass diode laser. Hair counts were done six and 18 months following five treatment sessions and were found to be comparable t90-94 percent hair reduction. Hair counts at six months following the fifth treatment were comparable to hair counts at 18 months, indicating that sixth-month hair counts can be considered indicative of long-term results. The low-fluence, multiple-pass in-motion technique was associated with significantly less pain compared to the high-fluence, single-pass technique. Multiple passes of a diode laser at low fluences but with high average power results in permanent hair removal with less discomfort and fewer adverse effects, especially in darker skin.
- A handpiece with a 35 × 22-mm treatment window that uses vacuum technology has been designed for the diode laser system. Vacuum suction stretches the skin and brings the hair follicle closer to the surface with the intent to damage the hair follicle at a lower surface fluence. The objective of this study was to compare the degree of follicular thermal damage between the sapphire-cooled smaller handpiece at a higher fluence versus the larger vacuum-assisted handpiece at a lower fluence. Five male patients with Fitzpatrick skin types I-IV were enrolled in the study. Three test spots on the right back were treated with the vacuum-assisted laser handpiece at a setting of 10-12 J/cm², and 61-ms pulse duration. Three test spots on the left back were treated with the sapphire-cooled handpiece with a setting of 30-34 J/cm² and a pulse duration of 14-16 ms. A punch biopsy was obtained from one treated area for each handpiece type. The biopsies were sectioned horizontally and examined for the degree of thermal damage to the hair follicle at the level of the isthmus and the bulb. Immediate treatment response, pain score, and total treatment time were recorded. Biopsies from the skin treated with the sapphire-cooled handpiece and the vacuum-assisted handpiece showed the mean hair follicle diameter was 258.3 µm (SE [standard error] 41.7) and 225.1 µm (SE 17.1), respectively. The mean thermal damage diameter to hair diameter ratio was 0.91 (SE 0.10) and 0.72 (SE 0.12), respectively. The mean immediate treatment response, the mean pain severity, and the mean total treatment time were all lower for the vacuum-assisted handpiece. Treatment with the vacuum-assisted handpiece is faster and has a tendency to be more comfortable. Thermal damage to the hair follicle was greater with the sapphire-cooled handpiece.
- More and more we are seeing depilatory mechanisms based on IPL technology and used at home. As far as we know, these appliance have not undergone either safety or efficacy testing. The aim of the study was to compare tolerance and efficacy of two depilation methods a medical device in-home-use IPL (E-One) and hot wax. Axillae of 63 persons were treated by either IPL (intense pulsed light) or hot wax for 49 weeks. Tolerance was assessed clinically by a dermatologist and efficacy by an independent blinded photographic assessment. Tolerance of the two methods is reasonably good with better results for the IPL treatment. IPL treatment is also much more efficient. This study confirmed good tolerance and excellent efficacy of this first one medical device used at home. Taking into consideration the mechanical action of the IPL and our experience, other cutaneous appliances (against wrinkles (or aging), hyperpigmentation. etc.) could be considered after optimization of the technical parameters.
- Based on the "gate theory" of pain transmission, pneumatic skin flattening (PSF) may reduce pain during laser hair removal. To compare the pain, efficacy, and adverse effects after laser hair reduction using PSF with that using a dynamic cooling device (DCD) in Asians. Twelve participants (skin types III-IV) received laser hair removal with a PSF device on the right axilla and DCD on the other side. Pain was assessed based on a visual analogue scale. Hair regrowth was rated based on photographs taken before treatment and in follow-up visits at 8 and 36 weeks. Sixty-seven percent of participants felt less pain in the PSF side than the DCD side right after laser treatment. On a scale of 1 to 10, the immediate mean pain score was 5.7±2.0 for the PSF side and 6.5±1.5 for the DCD side (p=.09). Seventy-five percent of the participants preferred treatments with PSF. Efficacy of hair reduction was similar on both sides 8 and 36 weeks after treatment. PSF decreases pain sensation during laser hair removal while allowing higher energy densities in Asian patients. The equal efficacy and complication rate of PSF indicates that it is a feasible alternative to DCD at lower cost.
- In spite of major advances in hair removal therapy, fine caliber hair remains a significant challenge for laser- and light-based devices. Evaluate a novel Electro-Optic (EO) Q-switched Nd:YAG laser for pigmented fine caliber hair removal in the Standard Single and a double pulse (DP) mode. Eleven patients underwent four laser treatments at monthly intervals. Bilateral anatomical regions received to one side the standard single pulse (SSP) while the other side the DP option. Blinded investigators conducted hair counts at 6 months post-treatment and after 24 months. Patients assessed hair loss and discomfort. Six patients rated their satisfaction at 6 months. At 6 months, investigators found a reduction of 50% in hair counts with the DP and 46% with standard pulse. Ninety percent in DP and 50% in SSP reported none to mild discomfort. Transient erythema and edema was observed with a lower severity rating with the DP. There were no other untoward effects. 83.3% of patients who completed the study at 6 months expressed satisfaction with the results. At 24 months hair loss was maintained at the same rate. The EO Q-switched Nd:YAG laser is an effective option for the permanent treatment of unwanted fine hair and has a high-patient satisfaction rate. There is less therapeutic discomfort in the DP mode.
- Hirsutism is a common disorder in women of reproductive age, and androgen disturbances may aggravate the condition. Limited evidence exists regarding efficacy of hair removal in this specific population and no data are available for patients with verified normal testosterone levels. To compare efficacy and safety of intense pulsed light (IPL) vs. long-pulsed diode laser (LPDL) in a well-defined group of hirsute women with normal testosterone levels. Thirty-one hirsute women received six allocated split-face treatments with IPL (525-1200 nm; Palomar Starlux IPL system) and LPDL (810 nm; Asclepion MeDioStar XT diode laser). Testosterone levels were measured three times during the study period. Patients with intrinsically normal or medically normalized testosterone levels throughout the study were included in efficacy assessments (n = 23). Endpoints were reduction in hair counts assessed by blinded photoevaluations at baseline and 1, 3 and 6 months after final treatment, patient-evaluated reduction in hairiness, patient satisfaction, treatment-related pain and adverse effects. IPL and LPDL reduced hair counts significantly, with median reductions from baseline of 77%, 53% and 40% for IPL and 68%, 60% and 34% for LDPL at 1, 3 and 6 months, respectively. At 6 months follow-up, there was no significant difference between treatments in terms of hair reduction (P = 0·427), patient assessment of hairiness (P = 0·250) and patient satisfaction (P = 0·125). Pain scores were consistently higher for IPL [median 6, interquartile range (IQR) 4-7] than LPDL (median 3, IQR 2-5) (P < 0·001). Hirsute women with normal or medically normalized testosterone levels responded equally well to IPL and LPDL treatments of facial hairiness, but the efficacy declined over 6 months.
- Hirsutism is defined as excess hair growth in androgen-dependent areas of the body in women. This article provides an updated review of hirsutism, focusing on the etiologies, clinical features, approach to diagnostic evaluation, and treatment options. The PubMed database was searched for English-language articles published from 1981 to the present, using the terms hirsutism, polycystic ovarian syndrome, congenital adrenal hyperplasia, hirsutism diagnosis, and hirsutism treatment. Reference lists from review articles on hirsutism during this time period were also examined. While there are many causes of hirsutism, the majority of patients have a benign process that may be idiopathic. In some circumstances, hirsutism is a sign of functional ovarian hyperandrogenism or congenital adrenal hyperplasia. Even more rarely, it is the presenting sign of an internal malignancy. Hirsutism clinically presents in women as excessive hair growth in androgen-dependent areas. It is a particularly important diagnosis to make, because it often significantly affects a woman's perception of her femininity and less commonly can be a sign of an underlying malignancy or a cutaneous manifestation of a condition with significant cardiovascular or other morbidity. A variety of treatments exist to help minimize the appearance of unwanted hair.
- Laser hair removal is a safe and effective procedure for the treatment of unwanted body hair but is not exempt from side effects. A rare but significant adverse effect with this treatment modality is paradoxical hypertrichosis. To evaluate the potential etiologies, risk factors, related laser types, and treatment options for the development of excess hair after laser therapy. An analysis of previously published case studies and review articles along with our own experience was used to gather information regarding this phenomenon. Paradoxical hypertrichosis has a low incidence, ranging from 0.6% to 10%, and most commonly occurs on the face and neck. All laser and light sources have the potential to cause hair induction, especially in individuals with darker skin types (III-VI); with dark, thick hair; and with underlying hormonal conditions. Possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Treatment for paradoxical hypertrichosis is laser therapy of the affected area. Paradoxical hypertrichosis is a rare side effect of laser hair removal; the pathogenesis of this event remains widely unknown. We recommend further large-scale studies to investigate this effect. The authors have indicated no significant interest with commercial supporters.
- Modern lasers and light-based sources that were developed based on the theory of selective photothermolysis are capable of destroying specific tissue targets while minimizing the risk of scarring and pigmentary changes. This is accomplished through the use of a wavelength and pulse duration that is best absorbed by a specific chromophore such as melanin or hemoglobin. However, not all lasers and light sources adhere to this principle. Continuous wave (CW) lasers are least selective and may produce unwanted tissue damage and scarring through heat conduction to normal skin. Quasi-CW lasers limit excessive thermal destruction by delivery of a series of brief laser pulses but still pose a higher risk of nonspecific tissue damage and thermal injury. The pulsed and Q-switched (QS) systems adhere most closely to the principles of selective photothermolysis and result in the highest degree of selective destruction with the lowest risk of scarring from excessive thermal diffusion. Certainly, any laser system potentially can result in scarring and tissue damage when used incorrectly; therefore, adequate operator education and skill are essential. Side effects and complications that occur as a consequence of laser treatment can be significantly reduced if diagnosed and treated in an expeditious manner.
- The surgical treatments for pilonidal sinus disease often result in recurrences, and the patients risk requiring multiple surgical interventions. To evaluate the role of alexandrite laser hair removal after surgery in pilonidal sinus disease. Sixty patients who underwent surgical treatment of pilonidal sinus disease and were treated with a 755-nm alexandrite laser after surgery between 1999 and 2007 were examined retrospectively. The charts were reviewed, and the patients were interviewed on the telephone about their post-laser period and recurrence. The laser parameters, patient history, and surgical details were recorded. The overall recurrence rate was 13.3%, after a mean follow-up period +/- standard error of the mean of 4.8 +/- 0.3 years. The mean number of laser treatment was 2.7 +/- 0.1. Seventy-five percent of the recurrences were detected after a follow-up period of 5 to 9 years. Fifty percent of the recurrent cases had drainage and secondary intention before the laser epilation. Our results strongly suggest that laser hair removal after surgical interventions in pilonidal sinus disease decreases the risk of recurrence over the long term.
- High fluence diode lasers with contact cooling have emerged as the gold standard to remove unwanted hair. However, laser hair removal is associated with pain and side effects, especially when treating dark or tanned skin. A novel diode laser with low level fluence (5-10 J/cm2) with a high repetition rate at 10 Hz (Soprano XL in SHR mode, Alma Lasers, Chicago, IL) using multiple passes in constant motion technique was compared to traditional one pass high fluence (25-40 J/cm2) diode laser (LightSheer ET, Lumenis, Santa Clara, CA) in a prospective, randomized split-leg study on 25 patients with Fitzpatrick skin types I-V. Hair counts were done six months following the fifth treatment and were found to be comparable with a 86-91% hair reduction. There was one superficial burn with the high energy diode treatment. The rapid, multiple pass in-motion technique was faster and associated with significantly less pain. Multiple passes of diode laser at low fluences but with high average power results in permanent hair removal with less discomfort and fewer adverse effects, especially on darker skin.
- The author has indicated no significant interest with commercial supporters.
- Hidradenitis suppurativa (HS) is a chronic suppurative condition for which there is limited efficacy of medical and surgical treatments. To assess whether the 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser is an effective treatment for HS. Prospective, randomized, controlled study for patients with stage II to III HS disease (n=22). A series of 3 monthly laser sessions were performed. Treatment response was measured before each laser session and 1 month after the completion of laser treatment (HS Lesion, Area, and Severity Index (HS-LASI) scale). A modification was made to include symptoms (erythema, edema, pain, and purulent discharge; modified HS-LASI, 0-3 scale). The percentage change in HS severity after 3 months of treatment was -65.3% over all anatomic sites, -73.4% inguinal, -62.0% axillary, and -53.1% inframammary. For all anatomic sites combined and each individual anatomic site, the change in HS severity from baseline to month 3 was statistically significant at the treated sites (p<.02 for modified HS-LASI and HS-LASI) but not at the control sites (p>.05 for modified HS-LASI and HS-LASI). The long-pulse Nd:YAG laser is effective for treatment of HS. The effectiveness of Nd:YAG laser, a hair epilation device, supports the primary follicular pathogenesis of the condition.
- Removal of unwanted hair is the most popular skin treatment worldwide. Over the past decade, various lasers and light sources for epilation have been advocated for use in an office setting, although most people continue to treat unwanted hair with a variety of temporary physical methods (e.g., waxing, shaving) in a home setting, presumably due to cost and convenience factors. To evaluate the safety and efficacy of a low-energy pulsed-light device intended for home-use hair removal. Twenty women (skin phototypes I-IV) with dark terminal hair in nonfacial sites (axilla, forearms, inguinal region, legs) self-administered three treatments at 2-week intervals using a handheld intense-pulsed-light device. Matched untreated skin sites were also studied. Hair counts and clinical photographs were obtained pretreatment and at 1, 3, and 6 months after the third treatment. Side effects and patient satisfaction scores were recorded. All patients showed a positive clinical response to treatment, with reduction of unwanted hair. No reduction of hair was noted in untreated matched areas. Hair counts were reduced 37.8% to 53.6% 6 months after the three treatments. Skin region influenced clinical response, with lower legs exhibiting greater hair reduction than arms and inguinal and axillary areas. Mild erythema was experienced in 25% of patients, but no other side effects or complications were encountered. Patient satisfaction scores were high, with all patients stating that they would purchase the device for future home use. CONCLUSIONS Low-energy pulsed light can be applied safely and effectively for at-home hair removal in a variety of nonfacial locations and skin phototypes I-IV.
- To report a series of patients with ocular complications associated with laser-assisted eyebrow hair removal. Case reports of three patients with eye pain and photophobia following laser epilation of the eyebrow region. The eye examination included visual acuity, slit-lamp examination, tonometry and fundoscopy. The follow-up period was 3 months. Each patient had conjunctival hyperaemia in one or both eyes and anterior chamber pigmentary cells. One patient presented with posterior synechiae, which did not respond to treatment. Laser epilation of the eyebrows may result in anterior uveitis as well as irreversible damage to the iris.
- Polycystic ovary syndrome (PCOS) is an insulin-resistant state with hirsutism as a common manifestation. We hypothesized that treatment with metformin would improve the cosmetic effects of intense pulsed light (IPL) therapy for hair removal in PCOS patients. In a prospective randomized controlled trial, 70 PCOS patients randomly received metformin (1,500 mg daily) + IPL therapy or IPL therapy alone for 5 IPL sessions during a 6-month period, followed by an additional 6 months of observation. Hirsutism score, homeostasis model assessment for insulin resistance (HOMA-IR), free androgen index (FAI) and patient satisfaction were evaluated at every visit. Fifty-two patients finished the study. Hirsutism was significantly better controlled in the metformin group (p = 0.009). Patient satisfaction was significantly better in the metformin group at the end of the observation period (52.9 vs. 34.1%, p = 0.019). HOMA-IR and FAI scores improved after metformin + IPL treatment (p < 0.05). Adding metformin to IPL in women with PCOS results in a significant improvement in insulin sensitivity and hirsutism.
- To evaluate the efficacy of a 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser using lower than traditional fluences (22-40 J/cm(2)) for treatment of pseudofolliculitis barbae (PFB). Twenty-two patients with PFB refractory to conservative therapy received five weekly treatments over the anterior neck using a 1,064-nm Nd:YAG laser at 12 J/cm(2). Pulse duration was 20 ms with 10 mm spot size. Topical anesthesia was not used. Treatments were completed 15 minutes after patient arrival. Patients presented for 2- and 4-week follow-up. Ten evaluators used a Global Assessment Scale (GAS) to assess dyspigmentation, papule counts, and cobblestoning by comparing baseline to 4-week follow-up visit photographs. Hair and papule counts were performed on five patients and compared with the GAS. Investigators recorded adverse effects using a visual analog and side effects scale. Eleven patients demonstrated 83% improvement on the GAS (p<.01). There was a mean reduction of 59.5% in dyspigmentation (p<.03), 91.2% in papule count (p<.01), and 75.6% in cobblestoning (p<.02). Patients reported 1 out of 10 on both adverse effects scales. Low-fluence 1,064-nm laser treatment achieved significant temporary reduction in PFB. Subjects noted minimal pain without topical anesthesia.
- To compare the long-term effectiveness and safety of long-pulsed Nd:YAG and alexandrite lasers, individually and in combination, in long-term leg hair reduction. Randomized, single-center, within-participant, investigator-blinded, active-controlled clinical trial. Private skin laser center. Twenty individuals aged 16 to 50 years with skin phototypes III and IV. The medial and lateral sides of each participant's legs were randomly assigned to receive 1 of the following laser treatments: (1) long-pulsed 1064-nm Nd:YAG laser (12-mm spot size); (2) long-pulsed 755-nm alexandrite laser (12-mm spot size); (3) long-pulsed 755-nm alexandrite laser (18-mm spot size); and (4) a combination of long-pulsed 1064-nm Nd:YAG laser and long-pulsed 755-nm alexandrite laser (treatments 1 and 2). Identified areas were treated for a total of 4 sessions at 8-week intervals. Hair reduction from baseline based on hair counting with digital photography by 2 blinded assessors, 8 and 18 months after the last treatment session. Fifteen participants completed the trial. The mean (SD) hair reduction 18 months after the last treatment, as measured by the assessors from digital photographs, were 75.9% (19.0%) for the 12-mm spot size alexandrite laser, 84.3% (12.4%) for the 18-mm spot size alexandrite laser, 73.6% (11.4%) for the Nd:YAG laser, and 77.8% (15.9%) for the combination therapy (analysis of variance, P > .05). The incidence of adverse effects (hyperpigmentation) and pain severity were significantly greater in areas that received combination therapy (P = .001). After 18 months of follow-up, alexandrite and Nd:YAG lasers were efficacious for leg hair removal. Combination therapy did not have any additional benefit and caused more adverse effects.
- The aim of this study was to compare the efficacy of topical piroxicam and EMLA cream on pain control and subsequent inflammation in neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser hair removal in female volunteers. Fifty female volunteers were enrolled in this prospective, randomized, double-blind, clinical study over a 6-month period. Patients were randomly assigned to receive topical piroxicam as group Piroxicam or EMLA cream as group EMLA. Topical analgesics were applied to the treatment sites for 60 min. The pain scores [on a visual analog scale (VAS)] and side effects were recorded before the hair removal, during the hair removal, at the end of the hair removal, and 1 h, 2 h and 24 h after the hair removal. Patients' characteristics and the treatment settings of the Nd:YAG 1,064 nm laser were similar in the two groups. The pain scores (VAS) were similar, and satisfaction was high in both groups after the hair removal. The number of blanching and erythema episodes were significantly higher in group E than in group P (P < 0.001). Inflammatory side effects were less frequent in group P than in group E after the procedure (P < 0.001). This study showed that topical piroxicam and EMLA provided adequate and similar pain relief after Nd:YAG 1,064 nm laser hair removal in female volunteers. Topical piroxicam was associated with fewer inflammatory side effects than was EMLA cream, because of its anti-inflammatory effect after the procedure.
- Physicians frequently recommend electroepilation (electrolysis) in the management of hirsutism, but there have been no English language reports of its clinical effectiveness. We performed over 35,000 hours of electroepilation (electrolysis) on two hundred eighty-one women over a 4-year period. We used conventional, commercially available electroepilation (electrolysis) equipment that produced both thermolysis and blend type currents. We found that electroepilation (electrolysis) helps control hirsutism, and 93% of the patients improved. There was no scarring. For best results electroepilation (electrolysis) must be combined with treatment of excess androgens. Instructions about good grooming and stressing that shaving is not harmful will help to maximize improvement in appearance. Electroepilation (electrolysis) is expensive and not readily available to those lacking insurance or other funding.
- A gate control system modulates sensory input from the skin before it evokes pain perception and response.
- Suitably brief pulses of selectively absorbed optical radiation can cause selective damage to pigmented structures, cells, and organelles in vivo. Precise aiming is unnecessary in this unique form of radiation injury because inherent optical and thermal properties provide target selectivity. A simple, predictive model is presented. Selective damage to cutaneous microvessels and to melanosomes within melanocytes is shown after 577-nanometer (3 x 10(-7) second) and 351-nanometer (2 x 10(-8) second) pulses, respectively. Hemodynamic, histological, and ultrastructural responses are discussed.
- Although many temporary treatments exist for hirsutism and hypertrichosis, a practical and permanent hair removal treatment is needed. Our purpose was to study the use of normal-mode ruby laser pulses (694 nm, 270 microseconds, 6 mm beam diameter) for hair follicle destruction by selective photothermolysis. Histologically assessed damage in ex vivo black-haired dog skin after the use of different laser fluences was used to design a human study; 13 volunteers with brown or black hair were exposed to normal-mode ruby laser pulses at fluences of 30 to 60 J/cm2, delivered to both shaved and wax-epilated skin sites. An optical delivery device designed to maximize light delivery to the reticular dermis was used. Hair regrowth was assessed at 1, 3, and 6 months after exposure by counting terminal hairs. Fluence-dependent selective thermal injury to follicles was observed histologically. There was a significant delay in hair growth in all subjects at all laser-treated sites compared with the unexposed shaven and epilated control sites. At 6 months, there was significant hair loss only in the areas shaved before treatment at the highest fluence. At 6 months, four subjects had less than 50% regrowth, two of whom showed no change between 3 and 6 months. Transient pigmentary changes were observed; there was no scarring. Selective photothermolysis of hair follicles with the normal-mode ruby laser produces a growth delay consistent with induction of prolonged telogen with apparently permanent hair removal in some cases.
- To assess the permanence of hair removal by normal-mode ruby laser treatment. Hair removal was measured for 2 years after a single treatment with normal-mode ruby laser pulses (694 nm, 270 microseconds, 6-mm beam diameter). Six test areas on the thighs or backs of 13 volunteers were exposed to normal-mode ruby laser pulses at fluences of 30 to 60 J/cm2 delivered to both shaved and wax-epilated skin. In addition, there was a shaved and wax-epilated control site. Terminal hairs were manually counted before and after laser exposure. Transient alopecia occurred in all 13 participants after laser exposure, consistent with induction of telogen. Two years after laser exposure, 4 participants still had obvious, significant hair loss at all laser-treated sites compared with the unexposed shaved and wax-epilated control sites. In all 4 participants, there was no significant change in hair counts 6 months, 1 year, and 2 years after laser exposure. Laser-induced alopecia correlated histologically with miniaturized, velluslike hair follicles. No scarring and no permanent pigmentary changes were observed. Permanent, nonscarring alopecia can be induced by a single treatment with high-fluence ruby laser pulses. Miniaturization of the terminal hair follicles seems to account for this response.
- Different techniques have been used for hair removal. Electrolytic epilation is a widely accepted method for this purpose. Recently laser hair removal was introduced. To evaluate and compare the effectiveness of long-pulse alexandrite laser hair removal with electrolytic epilation. Twenty-four areas of unwanted axillar hair in 12 patients were included in the study. The right axillar area of the patients was treated by electrolysis with an intensity of 4-8 mA, and the left area was treated with long-pulse alexandrite laser with fluences between 30 and 50 J/cm2. Electrolysis was performed four times at 3-week intervals, and laser treatment was performed three times at 4-week intervals. Before each session, the hairs in a 4 cm2 area centered in the axilla were counted. The last evaluation was done 6 months after the initial treatment. The pain, time, and cost of each procedure are compared. The average clearance rate of the hairs was 74% by laser and 35% by electrolysis 6 months after the initial treatment. Alexandrite laser hair removal is a more reliable and practical solution than electrolysis. Laser hair removal is more expensive than electrolysis, but is 60 times faster and less painful than electrolysis; also fewer sessions are needed with the laser with better results.
- Skin cooling is used to protect the epidermis in a variety of laser dermatology procedures, including leg vein treatment, hair removal, and port wine stain removal. Spray and contact cooling are the two most popular methods, but similarities and differences of these techniques are not well understood. A theoretical model of skin cooling is presented for two different regimens: "soft" cooling in which freezing of the skin is not permitted and "hard" cooling in which the skin can be frozen to a given depth. Spray and contact cooling were also compared experimentally using an in vitro model. For a fixed skin surface temperature, spray and contact cooling theoretically produce the same cooling profile in the skin. Anatomic depth of cooling depends on the time for which either the spray or contact is applied. In vitro experiments caused temperature at the simulated basal layer to be between -5 and +5 degrees C for both spray (tetrafluoroethane, boiling point -26 degrees C) and contact (-27 degrees C sapphire plate) cooling. The theoretical precooling analysis shows hard mode to be faster and more selective than soft mode; however, cooling time for hard mode must be carefully controlled to prevent irreversible epidermal damage caused by freezing. Both spray and contact cooling provide efficient skin cooling. The choice of cooling method depends on other factors such as the target depth, cost, safety, and ergonomic factors.
- The purpose of this study was to determine whether there were differences in outcome between patients treated by a trained physician and patients treated by a trained, supervised nurse. A total of 100 patients were treated for unwanted body hair using the Cynosure long-pulsed alexandrite laser: 50 patients were treated by a physician and 50 by a nurse. The measured average reduction in hair counts was 74 +/- 8% in the physician-treated group and 70 +/- 6% in the nurse-treated group (NS). Transient skin changes (i.e. pigmentation changes and blistering) were comparable between the two groups. Patient satisfaction measured by an assessment scale of 1 (excellent) to 5 (poor) was 1.6 +/- 0.3 and 1.4 +/- 0.3 in the physician- and nurse-treated groups respectively (NS). Using treatment efficacy, complication rate, and patient satisfaction as variables, this study concluded that properly trained physicians and nurses achieved parallel results in laser hair removal.
- We present a new theory of selective thermal damage of non-uniformly pigmented structures in biological tissues. Spatial separation of the heavily pigmented areas and the target requires limitation of the pigment temperature and heat diffusion from the pigmented to the targeted areas. A concept of selective target damage by heat diffusion is presented for three target geometries: planar, cylindrical, and spherical. An in vitro experiment is described in which the dependence of thermal damage on pulsewidth at constant fluence was evaluated. The in vitro experiment showed that the size of the damage zone for similar hair follicles was pulsewidth-independent over a very broad range of pulsewidths (30-400 ms). We formulated a new theory (extended theory of photothermolysis) to interpret the experimental results. Based on this new theory, the treatment pulsewidth for non-uniformly pigmented targets is significantly longer than the target thermal relaxation time (TRT). The theory provides new recommendations for photoepilation and photosclerotherapy parameters.
- Hirsutism affects 5-10% of unselected women, depending on ethnicity and definition. The past two decades have seen the development of lasers for the removal of unwanted hair, using selective destruction of the hair follicle without damage to adjacent tissues. Selective photothermolysis relies on the absorption of a brief radiation pulse by specific pigmented targets, which generates and confines the heat to that selected target. In general, laser hair removal is most successful in patients with lighter skin colours and dark coloured hairs. Some studies have documented the results of laser hair removal in a controlled setting, although few have extended their observations beyond 1 year. In general, treatment with the ruby, alexandrite or diode lasers, or the use of intense pulsed light results in similar success rates, although these are somewhat lower for the neodymium:Yttrium-Aluminum-Garnet (nd:YAG) laser. Overall, laser hair removal should not be considered 'permanent', at least when considering the current data available. Repeated therapies are necessary, although complete alopoecia is rarely achieved and it is unclear at what point the maximum benefit is achieved from multiple therapies. While larger prospective, controlled, blinded and uniform studies are still needed, laser hair removal appears to be a useful adjuvant in the treatment of the hirsute patient.
- Hirsutism is the presence of terminal (coarse) hairs in females in a male-like pattern, affecting between 5% and 15% of women, depending on definition. Hirsutism has a significant negative impact on psychosocial development and is usually a sign of an underlying endocrine abnormality-namely, androgen excess. The most common cause of androgen excess is the polycystic ovary syndrome (PCOS), with 21-hydroxylase-deficient nonclassic adrenal hyperplasia, the hyperandrogenic insulin-resistant acanthosis nigricans syndrome, androgen-secreting tumors, and androgenic drug intake occurring less frequently. However, although 70-80% of patients with androgen excess demonstrate hirsutism, this sign may be less prevalent among women of Asian extraction. Conversely, not all hirsute patients have evidence of detectable androgen excess, as 5-15% of these women have "idiopathic hirsutism," with normal ovulatory function and androgen levels. There is a strong familial predilection for hirsutism, primarily because the underlying endocrine disorders (eg, PCOS) and the factors regulating the development of hair growth (eg, androgen receptor activity, 5alpha-reductase activity) have a strong genetic component. The diagnostic evaluation of the potentially hirsute patient first involves confirming the presence of hirsutism and then excluding associated or etiological abnormalities and disorders (eg, ovulatory dysfunction, adrenal hyperplasia, diabetes, thyroid hormone abnormalities). Treatment should be undertaken using combination therapy, to possibly include 1) hormonal suppression (oral contraceptives, long-acting gonadotropin-releasing hormone analogues, and insulin sensitizers), 2) peripheral androgen blockade (spironolactone, flutamide, cyproterone acetate, or finasteride), and 3) mechanical/cosmetic amelioration and destruction of the unwanted hairs (electrology and, potentially, laser hair removal). The application of eflornithine hydrochloride 13.9% topical cream may also be useful to ameliorate unwanted facial hair growth. Overall, although hirsutism is a frequent and distressing abnormality often signaling an underlying endocrine disorder, a systematic approach to evaluation will uncover the etiology, and combination therapy will provide satisfactory treatment for most patients.
- Hirsutism, i.e. 'excess' body hair in the 'male' distribution, is a medical term applied only to women. Although associated with social and psychological difficulties including anxiety, social avoidance and a confusion of gender identity and although it raises important gender issues, there has been little systematic study. No prior research has focussed on the relationship between women's perceived degree of hirsutism and psychological distress. A survey of 53 women with polycystic ovary syndrome (PCOS), which often produces 'excess' hair growth, was carried out to assess any psychological consequences of perceived hirsutism. Results indicated raised levels of psychological distress overall, but no significant relationships between perceived hirsutism and distress. Four semi-structured interviews were then conducted to facilitate more in-depth exploration of hirsute women's experience. Analysis suggested idealized cultural norms for hair growth prevail and excess hair growth contributes to gender inconsistencies and feelings of deviance and stigma. Effective concealment of hair growth and 'passing' for normal appear to facilitate relatively high levels of functioning and allows idealized cultural norms to be maintained.
- This case report illustrates an adult presenting with the simultaneous occurrence of both methemoglobinemia (MetHb) and systemic toxicity from the topical application of local anesthetics while undergoing laser epilation therapy of the legs. The concurrent development of both is considered uncommon in this setting and may have been related to several factors, including her recent previous treatment, increased absorption secondary to abraded skin with the addition of occlusive dressing, and possible alteration of protein binding and drug metabolism due to the use of medications. The clinical manifestations and mechanisms of MetHb and systemic local anesthetic toxicity are discussed.
- Laser epilation is based on the principle of selective photothermolysis, absorption of laser energy by the target chromophore melanin. It is claimed that larger spot sizes may be more effective for hair removal at identical fluences. To compare the efficacy of 18- vs. 12-mm spot size in hair removal using a Gentlelase Alexandrite laser from Candela Corporation (Boston, MA). In this double-blind, randomized control trial, patients underwent laser-assisted hair removal on the axillary region. Regions were randomly selected and treated with either an 18- or a 12-mm spot size. Three treatments at 6-week intervals with a 755-nm Gentlelase Alexandrite laser (Candela Corp., Canton, MA) at a fluence of 16 J/cm(2) with cooling and delay times of 60 ms. Hair counts were taken before each treatment session and compared. The mean percentage hair reduction and student's paired t-test were used to compare 18 versus 12 mm versus control sites at each visit and compared it with the baseline hair count. There was a 10.3% difference in mean reduction favoring the 18-mm spot size treated area at the 6-month follow-up. Our results indicate that a larger spot size appears to be more effective for laser assisted hair removal.
- Laser hair removal is an effective therapy for the treatment of hirsutism, hypertrichosis, and pseudofolliculitis barbae. Although side effects are uncommon, pain is described by most patients undergoing long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser therapy. To compare the efficacy of topical eutectic mixture of local anesthetics (EMLA) versus topical lidocaine (LMX) in pain control for Nd:YAG 1,064 nm laser hair removal. Sixty-four patients were enrolled in a double-blind randomized study over a 6-month period. Each patient had half of the treatment area covered with EMLA and the other half with LMX 30 minutes prior to treatment. Neither was applied under occlusion. Immediately following their treatment session, patients completed a visual analog pain scale. There was no statistically significant difference in pain control between EMLA and LMX. However, female test subjects demonstrated lower pain scores than male test subjects. Nd:YAG 1,064 nm laser hair removal is a painful procedure. Topical anesthetics have been proven to reduce pain for laser hair removal. There is no statistically significant difference between the two most commonly used topical anesthetics for pain control in laser hair removal. Therefore, cost and minimizing potential side effects should guide the physician in selecting the appropriate anesthetic.
- Facial hirsutism is one of the characteristic features of polycystic ovary syndrome (PCOS), and this can lead to high levels of depression and anxiety. To evaluate the impact of laser treatment on the severity of facial hirsutism and on psychological morbidity in women with PCOS. A randomized controlled trial of five high-fluence treatments (intervention) vs. five low-fluence treatments (control) was performed over 6 months in a National Health Service teaching hospital. Subjects were 88 women with facial hirsutism due to PCOS recruited from hospital outpatient clinics and a patient support group in 2001-2002. The main outcomes were self-reported severity of facial hair (measured on a scale of 1-10), depression, anxiety (measured on the Hospital Anxiety and Depression Scale) and quality of life (measured on the WHOQOL-BREF). Self-reported severity of facial hair in the intervention group (n = 51) fell from 7.3 to 3.6 over the 6-month study period; for the control group (n = 37) the corresponding scores were 7.1 and 6.1. The change was significantly greater in the intervention group [ancova F((1,83)) = 24.5, P < 0.05]. Self-reported time spent on hair removal declined from 112 to 21 min per week in the intervention group and from 92 to 56 min in the control group [F((1,80)) = 10.2, P </= 0.05]. Mean depression scores fell from 6.7 to 3.6 in the intervention group, compared with 6.1 to 5.4 in the control group [F((1,83)) = 14.7, P < 0.05]. A similar change was seen for mean anxiety scores: intervention 11.1 to 8.2, control 9.6 to 9.3 [F((1,84)) = 17.8, P < 0.05]. Psychological quality of life also improved more in the intervention group, from 49.6 to 61.2 vs. 50.1 to 51.5 in the control group [F((1,84)) = 10.9, P < 0.05]. Laser treatment appeared to reduce the severity of facial hair and time spent on hair removal as well as alleviating depression and anxiety in women with PCOS. These findings suggest that ways of making this method of hair removal more widely available to women with facial hirsutism should be considered.
- Hair removal using lasers or broadband intense pulsed light has become one of the most ubiquitous medical procedures. At our center a small proportion of patients have spontaneously reported what they believed to be increased hair growth at sites of previous laser epilation. We sought to retrospectively review the prevalence and features of this paradoxical effect. This was a single center, retrospective study that included all patients who underwent laser hair removal during a 4-year period with a long-pulsed alexandrite laser. All cases of laser-induced hypertrichosis were assessed clinically by history, examination, and laboratory tests, and confirmed by review of serial clinical photographs taken during the course of the laser treatments. The clinical features of patients with postlaser hypertrichosis were compared with 50 patients randomly selected from among all those who had undergone laser hair removal at our center (n = 489). Of 489 patients, 3 (0.6%, 95% confidence interval: 0.01-1.9%) treated with the long-pulsed alexandrite laser (755 nm) reported increased hair after laser hair epilation. There was a trend for this adverse effect to occur in darker skin phototypes (IV) and with black hair as compared with the unaffected comparison group (n = 50). However, the small number of cases (n = 3) did not provide sufficient power to adequately test factors such as age, sex, treatment settings, and number of treatments statistically. Postlaser hair removal hypertrichosis is a real but rare occurrence in our experience.
- Twenty-two percent of women in North America have unwanted facial hair, which can cause embarrassment and result in a significant emotional burden. Treatment options include plucking, waxing (including the sugar forms), depilatories, bleaching, shaving, electrolysis, laser, intense pulsed light (IPL), and eflornithine 13.9% cream (Vaniqa, Barrier Therapeutics in Canada and Shire Pharmaceuticals elsewhere). Eflornithine 13.9% cream is a topical treatment that does not remove the hairs, but acts to reduce the rate of growth and appears to be effective for unwanted facial hair on the mustache and chin area. Eflornithine 13.9% cream can be used in combination with other treatments such as lasers and IPL to give the patient the best chance for successful hair removal.
- Unwanted hairs are a common problem in which different light sources were developed as the treatment of choice. Alexandrite laser, diode laser, and intense pulsed light (IPL) were clinically used for this purpose with long-term scarce comparative results. The objective of the study was to compare the clinical efficacy, complications, and long-term hair reduction of alexandrite laser, diode laser, and IPL. Clinical trials on 232 persons using diode, alexandrite, laser and IPL were conducted. The number of sessions to reach optimal result varied between 3 and 7. Then the side effects were evaluated. Six months after the last session, optimal hair reduction was observed with no significant differences between the light sources, but a hair reduction was found to be higher using the diode laser. Side effects were observed with all light sources but more frequently with diode. Our findings indicate that all three light sources tested have similar effects on hair removal and in Iranian patients, using lower wavelengths minimizes the side effects.
- Intense pulsed light (IPL) is an effective and safe hair removal method. However, it is not exempt from side effects. To evaluate clinical and hormonal characteristics of females with facial hirsutism that developed hair growth in untreated areas close to the area submitted to IPL photoepilation ("paradoxical effect"). A total of 49 females with facial hirsutism were included in a protocol of photoepilation with an IPL source. Hyperandrogenism of tumoral origin was excluded in all subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone (OHP), and sex hormone binding globulin (SHBG) were determined prior to IPL treatment. Clinical and photographic evaluation was performed immediately before each treatment session and 2, 6, and 9 months after the last treatment session. Only cases with "paradoxical effect" were included in this study. A total of five patients with "paradoxical effect" were identified. The patients' ranged in age from 13 to 44 years and all of them had skin phototype III (Fitzpatrick scale). All these subjects were diagnosed with polycystic ovarian syndrome and presented ovarian hyperandrogenism. Patients underwent six to nine IPL sessions, and "paradoxical effect" appeared at different times during the protocol, between treatment session 3 and 6 months after the conclusion of treatment. IPL may induce activation of dormant hair follicles in untreated areas close to hirsute-treated areas.
