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Original paper
Address for correspondence: Gunseli Seka Pancar, Department of Dermatology, Samsun Government Hospital, Samsun, Turkey,
e-mail: drgunseliseka@hotmail.com
Received: 14.03.2017, accepted: 1.08.2018.
The eects of 755 nm alexandrite laser on skin dryness
and pruritus
Gunseli Seka Pancar1, Goknur Kalkan2, Oznur Eyupoglu3
1Department of Dermatology, Samsun Government Hospital, Samsun, Turkey
²Department of Dermatology, School of Medicine, Yildirim Beyazit University, Ankara, Turkey
3Department of Statistics, Ondokuz Mayis University, Samsun, Turkey
Adv Dermatol Allergol 2020; XXXVII (1): 29–33
DOI: https://doi.org/10.5114/ada.2020.93381
Abstract
Introduction: The alexandrite laser (AL) is a very safe and eective treatment used for unwanted hair removal with
a reported success rate of 40% to 80% at 6 months and after several treatment sessions. Although a diuse variety
of side eects has been observed during laser treatment, changes in skin dryness and pruritus before and after AL
epilation have not been reported yet to the best of our knowledge.
Aim: To investigate the eects of 755 nm alexandrite laser on skin dryness and pruritus at the beginning and in the
third and the sixth month after the treatment.
Material and methods: Forty three patients with Fitzpatrick skin types of II–IV aged 18–45 with leg hair were
included in this prospective study. Patients were treated with 755 nm alexandrite laser with 10–12 mm spot size.
According to the skin phototype, the settings of the laser were as follows: 12–22 J/cm² and pulse width of 3 ms.
For self-assessment by the patient, the visual analogue scale (VAS) was used before, at the third and sixth month
of the treatment as to skin dryness and pruritus. The patients were evaluated by the same dermatologist with the
same VAS. The values were compared between before-at the third month, before-at the sixth month and at the
third and at the sixth month of the treatment.
Results: Pruritus scores were statistically lower at the third month when compared with the baseline scores
(p < 0.01). However, there was no dierence between the third and sixth month of the treatment as to pruritus
scores (p > 0.05). There was a statistically signicant dierence between the scores before the treatment and the
scores at the third month and at the sixth month as to skin dryness (p < 0.001). However, the dierence was not
prominent between the third and sixth month scores of skin dryness (p > 0.05).
Conclusions: To the best of our knowledge, this is the rst study researching the eects of AL on pruritus and skin
dryness. Further studies with larger samples and longer follow-up periods will be able to better clarify the associa-
tion.
Key words: alexandrite laser, skin dryness, pruritus, hair removal.
Introduction
Laser treatment has recently become a very popular
treatment procedure for the undesirable hair in aesthetic
and cosmetic practice. Several light and laser based pho-
toepilation methods have been used as the treatment
alternatives for unwanted hair removal. The red or near-
infrared wavelengths which are available for photoepila-
tion are about 600 to 1100 nm and include ruby laser
(694 nm), Nd:YAG (neodymium-doped yttrium alumini-
um garnet) laser (1064 nm), diode laser (800–810 nm)
and alexandrite laser (755 nm) [1]. In addition, intense
pulse light (IPL) (590–1200 nm) systems are used for epi-
lation although they are not true laser systems. The aim
of the laser hair removal is the destruction of the fol-
licular unit through thermal injury without damaging the
surrounding skin. Laser hair removal targets melanin (ab-
sorbing chromophore) in the hair bulb and shaft. Ther-
mal injury enlarges and results in the destruction of the
progenitor stem cell [1–3]. The choice of the wavelength
of the laser for hair removal varies among patients based
on the skin type, ethnicity, hair colour and anatomical
site [2]. The alexandrite laser (AL) is commonly used for
hair reduction with a reported success rate of 40% to
80% at 6 months and after several treatment sessions
Advances in Dermatology and Allergology 1, February / 202030
Gunseli Seka Pancar, Goknur Kalkan, Oznur Eyupoglu
[3, 4]. In general, laser hair removal remains a very safe
and eective treatment; however transient or persistent
side eects such as pain, erythema, oedema (10–17%),
hypo-hyperpigmentation (14–25%), blistering, crusting
(10–15%), erosions, purpura, scarring (0–5%) and follicu-
litis may be observed [5].
Besides, paradoxical hypertrichosis, superficial
thrombophlebitis, hyperhidrosis, bromhidrosis, and leu-
cotrichia have also been reported [6–9]. Although a dif-
fuse variety of side eects has been observed, changes
in skin dryness and pruritus before and after AL epilation
have not been reported yet to the best of our knowledge.
Aim
Therefore, in this study, we aimed to investigate the
eects of 755 nm AL (that is used for leg hair removal) on
skin dryness and pruritus before, at the end of 3-month
and 6-month follow-up.
Material and methods
Patient selection
Forty three patients with Fitzpatrick skin types of II–IV
aged 18–45 with leg hair were included in this prospec-
tive study. All of participants signed the informed con-
sent before starting any intervention. Exclusion criteria
consisted of current and planned pregnancy, lactation,
menopause patients with chronic systemic disease,
patients receiving systemic medications, previous laser
treatment for leg hair, dermatological disease located on
legs, patients who have keloid history, infection at the
treated area and tanned skin. Patients were treated with
755 nm AL (Light Age Inc, Epicare-LPXTM, USA) with 10–
12 mm spot size. According to the skin phototype, the
settings of the laser were as follows: 12–22 J cm² and
pulse width of 3 ms (repetition rate of 5 Hz). Cooling De-
vice (Zimmer Cryo 6, Cold Air Device, USA) was used dur-
ing the laser procedure. Patients were all evaluated by
a dermatologist.
Treatments were given monthly. Fluency was in-
creased if there were no side eects following the previ-
ous session. Pulse width remained constant.
For self-assessment by the patient, the visual ana-
logue scale (VAS) was used before, at the third and sixth
month of the treatment as to skin dryness and pruritus.
The patients were evaluated by the same dermatologist
with the same VAS. The patients were asked to quantify
the presence of skin dryness and pruritus using VAS at
10 points (0 – no dryness, no pruritus and 10 – most se-
vere dryness and pruritus). The physician also evaluated
dryness only with the same VAS. The values were com-
pared between before – at the third month, before – at
the sixth month and at the third and at the sixth month
of the treatment.
Statistical analysis
Statistical analysis was performed using SPSS 15.0
(SPSS, Inc, Chicago, IL, USA). Paired-samples t test and
Wilcoxon signed-rank test were used to determine
changes between baseline measures and those at the
third and at the sixth month of the treatment. The asso-
ciation between parameters was assessed by Pearson’s
correlation test. The level of statistical signicance was
set at p < 0.05.
Results
Forty-three patients (women) were enrolled in our
prospective analysis. The mean age was 32.34 ±87. The
patients had mostly type II–III and IV of Fitzpatrick’s skin
phenotype.
Pruritus score was 1.88 ±2.48 before treatment and it
was 0.005 ±0.30 at the third month. Pruritus scores were
statistically lower at the third month when compared
with the baseline scores (p < 0.01). However, there was
no dierence between the third and sixth month of the
treatment as to pruritus scores (p > 0.05). Skin dryness
was 0.67 ±1.08 before treatment and 2.35 ±2.21 at the
third month and 2.33 ±2.25 at the sixth month. There was
a statistically signicant dierence between the scores
before the treatment and the scores at the third month
and at the sixth month (p < 0.001). However, the dier-
ence was not prominent between third and sixth month
scores of skin dryness (p > 0.05).
Also, the physician assessment revealed that skin
dryness was signicant at the third and sixth months of
the laser treatment when compared with the baseline
scores (p = 0.001). The maximum score of 7 was given in
all of the groups. The results were summarized in Table 1.
Discussion
In this study, we investigated the eect of laser hair
removal on skin dryness and pruritus to determine
whether skin dryness is a newly reported adverse eect
or not during laser treatment and to detect if AL can be
used as a treatment model for the pruritus on legs. The
assessments were done at the beginning, at the third
and sixth month after the treatment. Pruritus scores at
the third month were found as statistically lower than the
scores at the beginning. A statistically signicant dier-
ence was also detected between the skin dryness scores
before the treatment and the scores at the third month
and at the sixth month of the treatment (p < 0.001).
To the best of our knowledge, this is the rst study
researching the eects of AL on pruritus and skin dry-
ness. We would like to attract attention to these rarely
seen eects of a very common technique that is used in
daily practice routinely and to alert our colleagues about
this issue.
Advances in Dermatology and Allergology 1, February / 2020
The eects of 755 nm alexandrite laser on skin dryness and pruritus
31
Alexandrite laser was revealed as the most effec-
tive and painless photoepilation method according to
the most of the results of the reported studies in the
literature [5, 9]. Hyperpigmentation, hypopigmenta-
tion, erythema, crusting and oedema are transient and
sometimes persistent common side eects of these la-
ser systems [5, 6]. Other uncommon side eects include
induction or aggravation of acne, rosacea-like rash, pre-
mature greying of hair, tunnelling of hair under the skin,
prolonged diuse redness and oedema of the face, and
severe persistent urticaria [5–9]. In our study, skin dry-
ness is newly diagnosed uncommon adverse eect. The
mechanism leading to dryness cannot be exactly under-
stood. However, the mechanisms proposed may be direct
thermal injury of the skin or indirect stimulation by nerve
bres, laser penetration and parameters, skin type, body
localization, seasonal changes, genetic factors and sun
exposure. Thermal injury leading to destruction of the
pilosebaceous unit and eccrine gland with secondary in-
ammation may be the other factor in the explanation
of the skin dryness after laser treatment.
The pilosebaceous unit (PSU) and eccrine sweat
gland (ESG) are classically described as completely in-
dependent skin appendages. The secretory segment of
the ESG approximates the hair follicle in a position below
the sebaceous gland. They are the major implications in
supporting the humidity of the skin [10]. The best known
diseases of the PSU and ESG are acne vulgaris, hidrad-
enitis suppurativa, rhinophyma and syringocystadenoma
papilliferum. Diode laser, pulsed dye laser and IPL were
used to improve these diseases [10, 11]. However, the ef-
fect of AL on PSU and is not fully known.
The outgrowth of cells from ESGs is the major fea-
ture of repair in the skin. Reduced outgrowths of ESG,
reduced cell-cell cohesiveness and reduced number of
desmosomes delay wound closure, lead to a thinner
epidermis and dry skin. Rittie et al. investigated the im-
paired wound closure and dryness in the elderly skin.
They suggested that reduced cell cohesiveness of out-
growths from eccrine sweat glands delays wound clo-
sure and leads to the dryness of the skin compared with
young adults [12]. We suppose that the eect of AL on
skin dryness may be with the same mechanism as act-
ing in the elderly skin. From this point of view, the histo-
pathological examinations, immunohistochemical and
electron microscopic studies should be done to rule out
the dryness process before and after laser application
on the skin.
Selective photothermolysis of melanin in hair follicles
is the main principle for laser assisted hair depilation.
However, the melanin in the epidermis must be pro-
tected. Dynamic cooling devices (DCD) are used for this
purpose. These devices use tetrauoroethane and have
a boiling point of –26.2°C. The liquid cryogen drop sets
undergo evaporation and cool epidermal temperature
[13, 14]. We also used this kind of devices to protect epi-
dermis in this study. We suggest that the uctuations of
the epidermal temperature may be the reason for the
skin dryness that was reported in our study. Further stud-
ies comparing skin dryness in two groups composed of
AL treatment with or without cooling systems are needed
to support and clear this suggestion. Nahm et al. reported
that cryogen usage during laser hair removal minimizes
the pain and protects the skin [13]. In fact, the patients
selected for epilation in this study consisted of mostly
lighter skin phototypes. As we know, higher fluencies
are used on lighter skin phototypes. As a result of the
changes in laser settings, the thermal energy delivering
to epidermis is more signicant than darker ones. Our
patient selection was also composed of lighter skin pho-
totypes, therefore the studies together with darker skin
phototypes should be organized for clarifying the eects
of AL on skin dryness in all types of phototypes.
Alavi et al. evaluated the effects of AL on skin pa-
rameters such as melanin content, skin layer depth, elas-
ticity, density and transepidermal water loss (TEWL) by
biometric methods [15]. They revealed that four sessions
(with 4-week intervals) of AL could decrease melanin
content of the skin and make the skin thinner, however
it could increase elasticity and density of epidermis and
dermis by decreasing TEWL. Decreased TEWL signied
the improved skin ability to retain its water and keep
the skin barrier intact [16]. As the decrease in epidermis
depth was especially caused by the decrease in stratum
corneum, we suggest that in our study the skin dryness
may be the result of the decreased layer of the epider-
mis, however to be able to have an assertive conclusion,
we should perform a biopsy and examine the epidermis
histopathologically during laser treatment. Unfortunate-
ly, we were unable to make pathological examination
in our study. Besides there are also more objective and
quantitative physical measurement systems such as ca-
pacitance measurement, infrared-spectroscopy, electrical
resistance measurement, resonance frequency measure-
ment, profilometry and scanning electron microscopy
for determining the dryness of the skin. Further studies
Table 1. The mean and median VAS scores
Variable Pruritus, mean ± SD Skin dryness, mean ± SD Observer, mean ± SD
Before the treatment 1.88 ±2.48 0.67 ±1.08 0.91 ±1.17
Third month 0.05 ±0.30 2.35 ±2.21 2.63 ±2.16
Sixth month 0.03 ±0.30 2.33 ±2.25 2.67 ±2.14
Advances in Dermatology and Allergology 1, February / 202032
Gunseli Seka Pancar, Goknur Kalkan, Oznur Eyupoglu
evaluating skin dryness with these methods will be much
better to clarify the eect of laser treatment on the skin.
In addition, the skin dryness and pruritus should be
evaluated and compared with other lasers that are used
for hair removal. The patients in our study had no other
side eects of laser treatment.
Current knowledge shows that dry skin is usually re-
lated with higher pruritus rates. However, our ndings
contradicted these data as skin dryness increased while
pruritus was decreasing. Therefore, we can infere that
something acts dierently in the laser irradiated skin.
These eects should be investigated to see if they are
transient or persistent, therefore a long follow-up period
will better illuminate these newly observed skin reac-
tions.
The expressions of inammatory cytokines with laser
irradiation have been reported in various studies. Shiba
et al. studied the Neodymium-daped yttrium-aluminium-
garnet laser (Nd:YAG) on IL-6 levels with the activated
protein kinase pathway resulting in the anti-inamma-
tory eect. Shiba et al. reported that the Neodymium-
daped yttrium-aluminium-garnet laser (Nd:YAG) irradia-
tion resulted in inhibition of the increase in IL-6 levels
through the activated protein kinase pathway resulting
in an anti-inammatory eect [17].
Dang et al. revealed that 532-nm laser and 1064-nm
laser accelerated collagen synthesis due to upregulation
of transforming growth factor β (TGF-β), Hsp 70 and IL-6
levels. TGF-β was also found to be up-regulated with
800-nm diode laser in another study. As a result of these
studies, we can conclude that laser irradiation inuences
the inammatory responses of the aected skin [18, 19].
Fractional CO2 and pulse dye laser were also reported
as useful laser techniques used to improve intense pru-
ritus in hypertrophic burn scars, which is an undesirable
consequence of these methods [20]. The eect of AL on
pruritus has not been reported in the literature until now.
In our study, pruritus scores were signicantly decreased
compared to the baseline scores before the treatment of
AL. Our ndings suggest that the anti-inammatory ef-
fects of lasers and the dierent distribution pattern of cy-
tokines after laser irradiation may be the sources of the
decreasing pruritus scores. In the light of these studies,
AL can be a promising treatment method for the patients
who are concerned about pruritus located on legs. How-
ever, additional studies are required in dierent sections
of the body by using immunohistochemical methods
concomitantly evaluating the patients with VAS to be
able to measure local cytokine distribution of the aect-
ed skin and observe the changing prole of inammatory
reaction to the laser therapy. Son et al. suggest that dry
skin is due to decreased bleomycin hydrolase expression
and reduction in laggrin degradation. Maintenance of
water balance in the stratum corneum is determined by
these factors and intercellular lipids in corneocytes [21].
Filaggrin degradation and intercellular lipid destruction
after the application of AL may be a causative factor of
skin dryness. However detailed studies are needed.
Consequently, laser treatment for hair removal oers
a comfortable and pleasing service that increases quality
of life. However, reported newly adverse eects have been
increasing with each passing day. Therefore, clinicians
should be alert and aware about these current skin reac-
tions of this common procedure and inform the patients.
Besides, contributions to the improvement of pru-
ritus are promising positive effects of AL on pruritus.
Further investigations with larger samples and longer
follow-up periods are required to be able to clear the ac-
curate mechanisms causing these skin changes and this
approach will be able to provide the eective usage of
these devices.
Conict of interest
The authors declare no conict of interest.
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