Article

Long-pulsed Nd:YAG laser vs. intense pulsed light for hair removal in dark skin: A randomized controlled trial

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Abstract

Although several lasers meet the wavelength criteria for selective follicular destruction, the treatment of darker skin phototypes is particularly challenging because absorption of laser energy by the targeted hairs is compromised by an increased concentration of epidermal melanin. To compare satisfaction level, safety and effectiveness of a long-pulsed Nd:YAG laser and intense pulsed light (IPL) in axillary hair reduction in subjects with dark skin. The study design was a within-patient, right-left, assessor-blinded, comparison of long-pulsed Nd:YAG laser and IPL. Fifty women (skin phototypes IV-VI) volunteered for removal of axillary hair. Five sessions at 4- to 6-week intervals were performed. Hair counts at both sides were compared at baseline and 6months after the last session. Final overall evaluations were performed by subjects and clinician at the end of the study. Satisfaction was scored for both devices. Thirty-nine women completed the study. At 6months, the decrease in hair counts on the laser side (79·4%, P<0·001 vs. pretreatment) was significantly (P<0·01) greater than that on the IPL side (54·4%, P<0·01 vs. pretreatment). Only temporary adverse effects were reported at both sides. Higher pain scores and more inflammation were reported with Nd:YAG laser; however, it was preferred by 29 volunteers (74%). Volunteers reported higher satisfaction score with Nd:YAG laser (P<0·01). Dark skin can be treated by both systems safely and effectively; however, long-pulsed (1064 nm) Nd:YAG laser is more effective as reported by both subjects and clinician.

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... Pulse duration varies in the millisecond (ms) domain, multiple passes 2-4 times with a various pulse delay interval may be used in a single session. In IPL machine, the use of cut-off filters with a wavelength range from 400 to 1200 nanometer that is emitted to the cutaneous target to prevent long wavelength to reach the target [8][9][10]. ...
... IPL devices have 2 benefits include lower price than laser and have filters that enable the application of the light on the larger surface area than in laser. However, they need more treatment sessions [10]. Many prior studies used IPL for the treatment of hirsutism with various number of sessions (1-13) [6,11,14,[18][19][20][21]. The current study used 6 sessions. ...
... Ismail from Jeddah, Saudi Arabia compared between long-pulsed Nd Yag laser and IPL on 2 sides of the axilla in same patient of the 39 hirsute women with 6 sessions for all subjects, he found that there was a significant decrease in hair counts (P-Value = 0.01) between laser (79.4%) and IPL side (54.4). This explains that Nd-Yag laser is more effective than IPL in dark-skinned ladies [10]. The present study revealed that 72.6%, 24.2%, and 3.2% of the ladies had transient erythema, perifollicular edema, and pigmentation, respectively. ...
... Light has been an important treatment tool for some types of esthetic dermatological affections for centuries; for this reason, phototherapy practice has evolved to the point where has become a standard treatment, particularly for dermatological conditions related to the pilous follicle and the structures around it, such as hirsutism, folliculitis, hypertrichoses, Becker's nevus, and esthetic epilation [1][2][3]. This therapy, known as epilation, is a non-surgical treatment based on light sources done to reduce the amount of hairs, growth of hair, or length of hairs with a lasting effect. ...
... This therapy, known as epilation, is a non-surgical treatment based on light sources done to reduce the amount of hairs, growth of hair, or length of hairs with a lasting effect. The therapy is performed by applying phototherapeutic resources, whose principles are based on selective photothermolysis [2]. ...
... Regarding the study designs, although all of them were randomized clinical trials, the randomization showed great variety: five were randomized controlled trials [2][3][4][5][6]9], three were randomized split face/axilla clinical trials [1,7,10], and four were assessor-blinded randomized trials [8,[11][12][13]. ...
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Using light sources in phototherapy has presented promising results regarding several types of facial and body skin affections for centuries. The neodymium-doped yttrium aluminum garnet (ND:YAG) 1064 nm laser has become a standard treatment in dermatology for dermatological disturbances related to the pilous follicle and the structures surrounding it. Despite the reports of its clinical benefits, few scientific studies show its actual safety and efficacy. To substantiate the effects, benefits, and safety of applying an ND:YAG 1064 laser in the epilation process during esthetic treatment, a systematic review was carried out between October 2018 and January 2019, on studies published in the last 20 years. Randomized clinical trials in humans were considered that evaluated the efficacy, safety, and benefits of ND:YAG laser application at 1064 nm wavelengths for hair removal. A total of 198 articles were identified; 58 articles remained after their titles and abstracts were read; and 21 articles were selected after the removal of duplicates. After the integral reading, 13 of these articles were included in the systematic review (734 patients). The ND:YAG 1064 nm laser presents safety and promising, beneficial effects in epilation. However, further scientific studies with better methodologic quality are necessary to better standardize ND:YAG laser therapy and clarify its parameters for photoepilation.
... There are numerous studies done to compare Nd:YAG versus IPL in patients with Fitzpatrick skin types I-III, but there is a dearth of literature looking into the efficacy of laser and IPL in skin types IV-VI (13,14,15). Moreover, there are no studies done in Indian population comparing the effectiveness of laser and IPL. ...
... After five sessions of treatment with the laser at 4-6 weeks interval and after six months follow-up, there was 54.4% decrease with p < 0.01 on the IPL side and 79.4% decrease with p < 0.001 on the Nd:YAG side. They concluded that long-pulsed (1064 nm) Nd: YAG laser is more effective as reported by both subjects and clinician (13). Another study of 11 females with a single dose of laser and IPL. ...
... In a previous study (13), patients documented less pain sensation in the IPL side (1.5 ± 1.9) compared to the laser side (2.4 ± 1.3) and the difference was statistically significant (p < 0.05) (13). In our study also, the pain severity scores were lesser on the IPL side (0.35 ± 0.56) compared to the laser side (0.91 ± 0.79) and the difference was statistically significant (p < 0.002). ...
Article
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Background and objectives: There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG Laser versus IPL in the darker skin types. Study design/materials and methods: Thirty nine patients included in Group-1 were treated with Nd:YAG and 31 in group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared. Results: Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p<0.023). There were no statistically significant difference noticed regarding hyperpigmentation in both the groups (p<0.115). Conclusion: Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups.
... 9 Compared to intense pulsed light, long-pulsed Nd: YAG laser has been found to be more effective -as reported by both subjects and clinicians. 10,11 Safety and efficacy of laser hair removal is compromised in patients with darker skin types with short-pulse durations and high fluences. 6,12 Tanning of skin Complications like first or second degree epidermal burns from short wavelengths exist. ...
... 30 Similarly some recent studies have demonstrated superior hair reducing efficacy of Nd: YAG laser over intense-pulsed light system in dark skin. 10,30 ...
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Conventional and advance technologies are available for laser hair removal. Complete and permanent hair reduction is not yet possible by treatment with lasers. Ideal patient for any conventional laser hair removal treatment is one who has thick, dark terminal hair, light skin and normal hormonal status. Factors that contribute to variable outcomes in laser hair removal can be broadly divided into patient related ones and the technology related ones. Skin type, hair color, thickness and density, degree of tan, hormonal dysfunction etc., constitute the patient related factors. The wavelength, fluence, spot size and pulse duration of the laser system are the technology related factors. There are some patients who respond variably, unpredictably or poorly to laser hair removal despite ensuring that indication for treatment is appropriate with adequate parameters of the laser system. This article reviews various patient related and technology related factors which lead to variable-to-poor outcomes in laser hair removal; and various challenges and limitations of laser hair removal technology in patients with dark skin types.
... Since then, many studies, including the current study, have confirmed this device's efficacy and safety profile, reporting a mean hair reduction of up to 80%. Ismail reported that at the six-month follow-up after all the procedures, patients treated with long-pulsed Nd:YAG laser experienced a 79.4% decrease in hair count [16]. Other studies reported a decrease in hair count from 50 to 60%, but this variability may be associated with the researcher experience, as well as with a different treatment protocol [17,18]. ...
Article
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Background and Objectives: Hair removal is a common cosmetic problem interesting more and more patients nowadays. Various laser treatments are currently available. Alexandrite and Nd:YAG laser are the most effective procedures in lighter and darker skin phototypes, respectively. Materials and Methods: A total of 40 patients seeking hair removal in one or more body areas with skin phototypes 2–6 was recruited to perform this study. Patients were divided into two groups. One group was treated with the standard Nd:YAG hair removal procedure, while the other group was treated with a new “in motion” Nd:YAG technology. Results and hair removal rates were evaluated six months after the last treatment. Results: Out of 40 patients treated, all patients experienced hair reduction. No statistically significant difference in hair removal was noted between the two groups; however, a statistically significant reduction in pain during the procedure was observed in the group treated with the “in motion” technique. Conclusions: While traditional and “in motion” Nd:YAG techniques have similar result outcomes in hair removal, the “in motion” technology seems to guarantee a better safety profile compared with the traditional technique. A more extensive clinical study will be necessary to confirm our study’s results.
... 35 With appropriate settings, LHR patients typically report only minor, temporary side effects, with minimal risk of scarring. 45,47 One common misconception regarding LHR is that it is only effective in patients with light skin tones, due to competitive light absorption from epidermal melanin. 48 Multiple studies have actually found satisfactory results with LHR in darkerskinned patients (Fitzpatrick IV−VI). ...
Article
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Introduction Permanent genital hair removal is required before gender-affirming vaginoplasty to prevent hair-related complications. No previous studies have directly compared the relative efficacy, costs, and patient experiences with laser hair removal (LHR) vs electrolysis treatments. Food and Drug Administration (FDA) oversight of medical devices is poorly understood and commonly misrepresented, adversely affecting patient care. Aim This study compares treatment outcomes of electrolysis and LHR for genital hair removal and investigates FDA regulation of electrolysis and LHR devices. Methods Penile-inversion vaginoplasty and shallow-depth vaginoplasty patients completed surveys about their preoperative hair removal, including procedure type, number/frequency of sessions, cost, and discomfort. Publicly available FDA-review documents and databases were reviewed. Main Outcomes Measure Compared to electrolysis, LHR was associated with greater efficiency, decreased cost, decreased pain, and improved patient satisfaction. Results Of 52 total (44 full-depth and 8 shallow-depth) vaginoplasty patients, 22 of 52 underwent electrolysis only, 15 of 52 underwent laser only, and 15 of 52 used both techniques. Compared to patients that underwent LHR only, patients that underwent only electrolysis required a significantly greater number of treatment sessions (mean 24.3 electrolysis vs 8.1 LHR sessions, P < .01) and more frequent sessions (every 2.4 weeks for electrolysis vs 5.3 weeks for LHR, P < .01) to complete treatment (defined as absence of re-growth over 2 months). Electrolysis sessions were significantly longer than LHR sessions (152 minutes vs 26 minutes, P < .01). Total treatment costs for electrolysis ($5,161) were significantly greater than for laser ($981, P < .01). Electrolysis was associated with greater pain and significantly increased need for pretreatment analgesia, which further contributed to higher net costs for treatment with electrolysis vs laser. Many LHR and electrolysis devices have been FDA-cleared for safety, but the FDA does not assess or compare clinical efficacy or efficiency. Clinical Implications For patients with dark-pigmented hair, providers should consider LHR as the first-line treatment option for preoperative hair removal before gender-affirming vaginoplasty. Strength and Limitations This is the first study to compare electrolysis and LHR for genital hair removal. The discussion addresses FDA review/oversight of devices, which is commonly misrepresented. Limitations include the survey format for data collection. Conclusion When compared with electrolysis, LHR showed greater treatment efficiency (shorter and fewer treatment sessions to complete treatment), less pain, greater tolerability, and lower total cost. Our data suggests that, for patients with dark genital hair, providers should consider recommending laser as the first-line treatment for permanent genital hair removal before vaginoplasty. Yuan N, Feldman A, Chin P, et al. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022;10:100545.
... There have been many non-RCTs (39)(40)(41)(42)(43)(44)(45) and RCTs (38,(46)(47)(48)(49)(50)(51) on the efficacy of laser and IPL-based hair removal previously, most of which only follow participants short term (39,41,42,45). There is evidence that some trial (51) definitions of "long-term" hair reduction fail to take into account the sitespecific periods of hair growth cycles of the areas they measured long-term hair reduction for. ...
Article
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Laser and light-based devices provide scope for long-term "hair-removal" however, there is limited evidence supporting their long-term efficacy. This study aimed to assess the long-term efficacy of laser and light-based "hair-removal" devices, taking into account variations in body site-specific variations in hair growthcycles. A systematic review of randomized controlled trials (RCTs) with follow-up periods greater than or equal to the length of one complete hair growth cycle in the body site targeted was conducted. Only five eligible RCTs were identified as suitable for inclusion, and these comprised a total of 223 patients. The average long-term hair reduction reported for neodymium:yttrium-aluminum-garnet (Nd:YAG) laser ranged from 30 to 73.61%, Alexandrite laser ranged from 35 to 84.25%, and Diode laser ranged from 32.5 to 69.2%. In all three devices, the greatest long-term reduction was observed from trials targeting leg hair (1-year growth cycle) and lowest from targeting facial hair (6-month growth cycle). Intense pulsed light (IPL) produced average long-term hair reduction of 52.7-27%; smallest reduction was observed from targeting the face area and greatest from targeting the axillary area (7-month growth cycle). In conclusion, greater long-term hair reduction was observed on body sites with longer hair growth cycles. Future trials should take into account the varyiation of hair growth cycles across body sites to provide accurate long-term data on treatment outcomes.
... 3,4 Nd:YAG (1064 nm) lasers have the deepest penetration and appear to be safe in skin of color patients with less side effects reported, compared with other wavelengths. 3,[5][6][7][8][9] LHR works on the principle of selective photothermolysis-the laser light is selectively absorbed by melanin, which is abundant in the hair shaft, and damages the hair follicle without damaging the skin. 10 The theory states that the pulse duration should be equal or shorter to the thermal relaxation time (TRT) of the hair shaft in order to be effective in hair follicle destruction. ...
Article
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Background: Laser hair reduction gained popularity in the last decade and is presently the most frequently used long-term hair removal method. It works on the principle of selective photothermolysis - the laser damages the hair follicle without damaging the skin. Shorter Nd:YAG pulses are also effective in hair reduction, while maintaining better comfort for the patient. Aims: The aim of this study was to compare the short and long pulsed methods of Nd:YAG for facial hair removal on darker Fitzpatrick skin types (IV-V). Patients/methods: This prospective split face, evaluator-blinded comparison of short-pulse Nd:YAG laser vs long-pulse Nd:YAG laser study included 10 untanned healthy women. There were two outcome measers, two blinded dermatologists compared baseline photographs to those taken 3 months after last session and FotoFinder was used to compare the terminal hair count reduction at the baseline and 3 months after 6th session. Results: Both blinded assesors observed significant hair reduction with both lasers; excellent results were achieved in 20% with long pulse and in 55% with short pulse. Both treatment options showed reduction in number of terminal hair with statistical significance using FotoFinder. Comparison of the efficacy of the two pulse durations measured by percent reduction in the number of terminal hair 3 months after the last session showed no significant difference between the groups. Conclusion: Hair reduction using 1064 nm Nd:YAG is a safe and effective method of hair reduction especially in darker skin types. We have shown that short pulses are better or at least equally safe and effective as the "gold standard" long pulses.
... Bei Hauttypen IV bis VI konnte für den lang gepulsten Nd:YAG-Laser ein effektiver Haarverlust über mind. 6 Monaten gezeigt werden, ohne Dyspigmentierung oder Verbrennungen zu verursachen [34]. Viele Experten erachten daher den lang gepulsten Nd:YAG-Laser als am besten geeignet für die Haarentfernung bei dunkleren Hauttypen [5]. ...
Article
Zusammenfassung Die Fotoepilation zählt zu den meistgefragten nichtchirurgischen Eingriffen in der ästhetischen Dermatologie. Haarlose, glatte Beine gelten dabei als Schönheitsideal. Fotoepilation mittels Laser oder hochenergetischer Blitzlampen (sog. Intensed-Pulsed-Light-Geräte) stellt ein sicheres und effektives Verfahren dar. Der Wirkmechanismus beruht auf dem Prinzip der selektiven Fotothermolyse, wobei eine gezielte thermische Schädigung pigmentierter Haarfollikel unter Schonung des umliegenden Gewebes erfolgt. Melaninpigment des Haarschaftes absorbiert als Zielchromophor Licht eines speziellen Wellenlängenspektrums und führt durch Wärmediffusion zur Schädigung der für das Haarwachstum wichtigen Stammzellen im äußeren Haarwurzelschaft. Patienten müssen über die Notwendigkeit wiederholter Behandlungen sowie den häufig nur partiellen und temporären Haarverlust aufgeklärt werden. Dunkle Terminalhaare bei hellen Hauttypen lassen sich effektiv entfernen. Bei dunklen Hauttypen besteht aufgrund des erhöhten epidermalen Melaninvorkommens ein erhöhtes Risiko für Nebenwirkungen wie Verbrennungen, Dyspigmentierungen und Narben. Sehr feine, helle oder rote Haare lassen sich kaum mit konventionellen Fotoepilationsverfahren entfernen. Haarentfernungsgeräte für den Heimgebrauch sind eine kostengünstige, einfach anzuwendende Alternative, weisen aber im Vergleich zur professionellen Fotoepilation eine geringere Effektivität auf.
... Several researchers pointed out that the 1064-nm Nd: YAG laser has an impressive reduction in hair regrowth in individuals with dark skin [12][13][14][15]. Besides, the effectiveness of hair removal with the long-pulsed 755-nm Alex laser was first described by Finkel et al. [16]. ...
Article
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Background Laser hair removal has become popular means of achieving hair reduction with improved quality of life. Objective This study aimed to assess the safety and efficacy of Multipass low fluence, high-frequency 755-nm Alexandrite laser versus the high fluence, low-frequency 1064-nm long-pulsed Nd: YAG laser on axillary hair reduction in women with dark skin phototypes. Patients and Methods This study was carried out on 30 adult women [skin type, IV-VI)] who seek axillary hair reduction. These subjects were adjusted to receive 5 laser sessions with a 1-month interval. One side received high fluence, low-frequency 1064-nm laser where the other side received multipass low fluence, high-frequency 755 nm laser. The follow up was done using photographs, folliscope, patients’ visual analog pain scale. Results The mean percentage of hair density reduction showed significant improvement in both treated sides being higher in the Alex treated side with corresponding significant decreases in the mean hair thickness. Conclusion Multipass low fluence, high-frequency 755-nm Alex laser practice was verified to be safe and effective for hair removal in dark skin phototypes compared to the high fluence, low frequency 1064-nm long pulsed Nd:YAG laser.
... One of the possible reasons for Nd:YAG being the most commonly investigated hair removal device in HS is its higher efficacy and safety profile in darker skin patients given the higher likelihood of these individuals being affected by the disease (40). It is yet to be proven whether the earlier use of non-ablative light-based therapies such as Nd:YAG in HS can actually alter the natural history of the disease or delay the progression from Hurley I to stages II-III. ...
Article
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Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that may be treated with non-ablative light-based devices; however, no systematic reviews on the topic exist to date. We conducted a systematic review and meta-analysis to determine efficacy of non-ablative light-based devices in treating HS. Specifically, a systematic review was conducted using MEDLINE, EMBASE, Web of Science and CINAHL. We analyzed the use of non-ablative light-based devices in the treatment of HS. At least two investigators performed title/abstract review and data extraction. Meta-analysis was conducted using comprehensive meta-analysis software. 5 RCTs and 11 case reports/series were included (n = 211 unique patients). No observational studies were found. For Nd:YAG laser, meta-analysis of 3 RCTs reported improvement in modified HS Lesion Area and Severity Index (HS-LASI) when compared to control subjects. In addition, three case reports/series reported HS-LASI, Physician Global Assessment (PGA) scores and number-of-lesion improvements in treated patients. For intense pulsed light (IPL), two RCTs reported HS-LASI and Dermatology Life Quality Index (DLQI) score improvements. For Alexandrite laser, one case report showed lesion improvement. In conclusion, meta-analysis of Nd:YAG laser in HS patients suggests significant improvement in HS-LASI scores. For IPL, evidence is limited, but suggests improvement in HS-LASI and DLQI scores. For Alexandrite laser, evidence precludes conclusions. Given small sample sizes and inconsistent reporting scales, larger RCTs are required to better determine the efficacy of these modalities in treating HS. © Copyright © 2020 Jfri, Saxena, Rouette, Netchiporouk, Barolet, O'Brien, Barolet and Litvinov.
... The majority of studies have documented a superior efficacy of alexandrite and diode laser systems in hair removal in comparison with other lasers or light-based devices. In a study that compared the efficacy of 3 laser devices, a mean hair reduction of 59.5%, 70.3%, and 47.4% was reported after 3 sessions with diode, alexandrite, and Nd:YAG lasers, respectively [29,30]. In a randomized, split-face study, a mean reduction in hair count of 46% and 27% was reported after alexandrite and intense pulsed light systems, respectively [31]. ...
Article
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Unwanted hair growth, which is a common aesthetic problem, has traditionally been treated using various techniques such as shaving, waxing, and epilation, but most of these provide only a temporary solution. Laser and light-based technology for hair removal has become one of the fastest growing procedures in modern cosmetic dermatology in the last decade. Clinical experience suggests that in the ideal subject with fair skin and dark hair, laser treatment can reduce hair growth significantly. This article reviews the various laser and light-based devices used for hair removal along with the various laser and patient parameters that affect the outcome of laser treatment for hair removal. Photoepilation, when properly used, offers clear advantages when compared with older, traditional techniques.
... All studies comparing IPL and Nd:YAG systems in terms of pain have used therapies for purposes of epilation. However, since the systems used differ, it is not possible to perform any direct comparison between them, although, in contrast to our findings, studies have generally reported that IPL systems caused less pain than Nd:YAG procedures [37][38][39][40][41] . ...
Article
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Background and Design: The aim of this study was to evaluate the efficacy and safety of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser and intense pulsed light (IPL) systems, and the variety of indications involved. Materials and Methods: First-year treatments in our clinic were evaluated retrospectively. Results were classified according to improvement rates: 75% as excellent improvement. Results: One hundred thirty-three patients aged 3-79 years (mean: 35.91) with 14 different indications were treated. Pigmented lesions were treated with IPL, and vascular lesions with IPL and/or Nd: YAG. Combined therapy with IPL and Nd: YAG at two-week intervals resulted in excellent improvement in 70.21% of vascular lesions (34 rosacea, 8 nevus flammeus, and 5 hemangioma), and moderate improvement in the rest. Telangiectasia and angiomatous lesions exhibited excellent improvement in 93.65% of patients with Nd: YAG, and moderate improvement in the rest. IPL resulted in excellent improvement in 78.49% of cases of solar lentigo, and moderate improvement in the rest. Moderate improvement was observed in 66.67% of patients with melasma using IPL, and mild improvement in the rest. Pain scores were significantly lower with Nd: YAG than IPL (p
... Hence over the past decade, laser technology has been the subject of much interest and demand for both clinicians and patients. 1 The basis of laser hair removal is the induction of hair follicle damage through the Specific targeting of melanin in the hair bulb. Currently several lasers or light devices of different wavelengths including ruby, alexandrite, long-pulsed neodymium-doped yttriumaluminumgarnet (Nd:YAG), diode lasers and intense pulsed light (IPL) are utilized in clinical practice and several studies have reported varying but good results. ...
... Puri [20] Diode, Nd: YAG, IPL Efficacy: Diode >Nd: YAG >IPL Safety: IPL >Nd: YAG >diode Study performed on darker skin types Karaca et al. [19] Alexandrite, Nd: YAG, IPL Efficacy: Alexandrite >IPL >Nd: YAG 3 sittings in skin Types I to IV Ismail [21] Nd: YAG, IPL Nd: YAG was more efficacious than IPL but IPL had lower pain scores Skin Types IV and V, axillary hair Sochor et al. [22] Diode, IPL, IPL+RF Efficacy: Diode=(IPL+RF) > IPL Pain scores: Least for IPL, highest for diode Fairer skin types McGill et al. [2] Alexandrite, IPL ...
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Background: Excessive hair on the face is a significant cause for distress amongst women. Permanent hair reduction methods including lasers and pulsed light devices are increasingly being used. Aims: The aim of this study is to evaluate the efficacy and safety of near infrared pulsed light source for permanent hair reduction in women seeking treatment for excessive hair growth on the upper lip and chin. Settings and design: This was a prospective observational study done at a tertiary care hospital in South India. Materials and methods: Women above 18 years of age were observed for six sittings of the treatment for excessive hair over the upper lip and chin using a near infrared intense pulsed light device. Efficacy was evaluated by measuring percentage hair reduction using digital photography. Further, efficacy amongst women with polycystic ovarian syndrome (PCOS) was compared with those without PCOS. Side effects were noted. Statistical analysis used: Student's unpaired t-test using the software SPSS version 16. Results: Percentage hair reduction at the end of 6 sittings in 24 women for the upper lip and chin was 52.87% and 73.81%, respectively. Out of the 24 women, 12 had PCOS and the difference in hair reduction in these women was statistically insignificant when compared to that observed in those without PCOS. Only two patients experienced side effects in the form of mild pain and discomfort. Conclusions: Intense pulsed light is a safe and efficacious tool for permanent hair reduction over the upper lip and chin, efficacy being similar in patients with or without PCOS.
... In these cases, it is recommended to use longer wavelengths (more than 755 nm), longer pulse durations with interpulse periods of 50-100 ms, and cooling systems to minimize thermal damage. 3,79 Ismael 79 conducted a study in 2012 with 50 women of phototypes iv-vi, and assessed the efficacy and safety of Nd:YAG laser compared to IPL in axillar hair removal, with the best results obtained for the laser system, although this treatment was more painful and led to greater inflammation. ...
Article
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Intense pulsed light (IPL) systems have evolved since they were introduced into medical practice 20 years ago. Pulsed light is noncoherent, noncollimated, polychromatic light energy emitted at different wavelengths that target specific chromophores. This selective targeting capability makes IPL a versatile therapy with many applications, from the treatment of pigmented or vascular lesions to hair removal and skin rejuvenation. Its large spot size ensures a high skin coverage rate. The nonablative nature of IPL makes it an increasingly attractive alternative for patients unwilling to accept the adverse effects associated with other procedures, which additionally require prolonged absence from work and social activities. In many cases, IPL is similar to laser therapy in effectiveness, and its versatility, convenience, and safety will lead to an expanded range of applications and possibilities in coming years.
... The author explained this with the long pulse Nd: YAG laser being able to penetrate 5-7 mm depth into the dermis in contrast to the short wavelength IPL system used in this study. Recently in a comparative study of Nd: YAG and IPL systems in dark skinned individuals, the Nd: YAG system was found most efficient after five treatments (16). ...
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Objective: Multiple lasers and light sources are currently available for hair removal and many studies comparing efficacy and safety exist. SHR mode IPL is a technique that gives the total energy in divided doses with fewer side effects. We compared a SHR mode IPL system with alexandrite and Nd: YAG lasers for leg hair reduction. Material and methods: Twenty-five female participants with skin types II-IV, underwent treatment of unwanted hair on the cruris. Three selected areas were randomly treated with the SHR mode IPL system, Alexandrite laser and Nd: YAG laser in three sessions. Hair reduction was evaluated with digital photography by a blinded assessor every 6 weeks and 6 months after the last session. Pain severity, side effects and patient satisfaction analysis were also investigated. Results: Twenty-one participants completed the trial. The mean hair reductions in 6 weeks after the last treatment were 50% for the IPL system, 53% for Alexandrite and 39% for the Nd: YAG lasers. However after 6 months; 40%, 49% and 34% hair reduction was observed, respectively. The Alexandrite laser was the least painful system. Conclusion: Although there is no obvious advantage of one laser system over the others in terms of treatment outcome, the Alexandrite laser is still the most efficient and reliable way of hair removal in fair skinned individuals.
Article
Objective To investigate the heterogeneity of treatment effects (HTE) of laser epilation in preventing pilonidal disease recurrence through analysis of prespecified clinical factors. Background Pilonidal disease is a common, painful disease affecting 1% of the population aged 15 to 30 years with postoperative recurrence rates as high as 30% to 40%. Methods Single-institution randomized controlled trial from September 2017 to September 2022 with 1-year follow-up, including patients aged 11 to 21 years with pilonidal disease undergoing gluteal cleft laser epilation and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone. Results In total, 302 patients were enrolled with 151 randomized to each intervention. 1-year follow-up was available for 96 patients in the laser group and 134 in the standard care group. There were no significant differences in treatment effects based on sex, body mass index, previous disease, prior surgical excision, or annual household income (all P > 0.05). HTE was identified by race and ethnicity ( P = 0.005) and health insurance type ( P = 0.001). Recurrence among non-Hispanic white patients was 4% (3/75) with laser treatment and 31.6% (31/98) with standard care versus 38.9% (7/18) with laser treatment and 38.2% (13/34) with standard care among all other racial/ethnic groups. Recurrence rates among privately insured patients were 4.0% (3/75) with laser treatment and 33.3% (29/87) with standard care versus 36.8% (7/19) with laser treatment and 29.7% (11/37) with standard care in patients with public insurance. Conclusions The effectiveness of laser epilation to reduce pilonidal disease recurrence rates may vary based on race and ethnicity and insurance type. Additional studies are warranted to investigate this potential HTE.
Article
Background The use of intense pulsed light (IPL) for hair removal has proven to be quite effective for conditions such as hypertrichosis and hirsutism, as well as other skin conditions related to the pilosebaceous unit. IPL was developed in the 1990s and uses a broad spectrum of light to penetrate the skin and reach the hair follicle, enabling treatment for various skin types and hair colors. This review covers the history, mechanism of action, effectiveness, patient selection, and clinical applications of IPL hair removal. Methods To conduct this review, a comprehensive literature search was conducted to identify relevant peer‐reviewed articles in English discussing the clinical use or application‐based outcomes of this technology specifically for hair removal. The search covered the period from January 1990 to May 2024. Results The review of 33 peer‐reviewed articles shows that IPL has significantly advanced hair removal treatment since its inception. A popular choice in clinical practice due to its efficacy, safety, and versatility, IPL hair removal has been successfully used in patients with skin conditions like acne, folliculitis, rosacea, and hyperpigmentation, offering additional benefits compared to laser hair removal. Conclusion IPL hair removal is a safe and effective option for reducing unwanted hair and improving skin appearance. It can also treat multiple skin conditions simultaneously with a low risk of side effects. Additionally, it's less painful than laser hair removal, making it an attractive option for long‐lasting hair removal, especially for patients with co‐existing dermatological conditions.
Article
Lower leg hair removal is the method of reducing unwanted lower leg hair. Various technologies for lower leg hair removal include Intense Pulsed Light (IPL), alexandrite laser, and neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Conventional techniques are abandoned because effectiveness of the latest technological therapies has a longer period with minimal side effects. The comparison of successful treatment among IPL, alexandrite laser, and Nd:YAG laser for lower leg hair removal. Two patients, male and female, 28 years old, Fitzpatrick IV skin type. Three areas in the lower legs are marked for IPL 695 nm, fluence 15 J/cm ² , pulse duration 60 ms; alexandrite 755 nm, fluence 3 J/cm ² , pulse duration 2 ms, long-pulsed Nd:YAG 1064 nm, fluence 32 J/cm ² , pulse duration 60 ms. IPL for 3 sessions at 2-week intervals. The alexandrite and Nd:YAG lasers for 3 sessions at 4-week intervals. Successful parameters with hair reduction and Visual Analog Scale (VAS) can be seen from photography and dermoscopy before and after therapy. In the first case, the most effective reduction terminal hair after IPL (95,1%), alexandrite (91,02%) and Nd:YAG (79,69%), respectively. In the second case, the most effective reduction of terminal hair after alexandrite (91,02%), Nd:YAG (79,69%), and IPL (20%), respectively. Hyperpigmentation and the highest VAS score (6–7) are found in the area treated with alexandrite lasers of two patients. Two patients have decreased Dermatology Life Quality Index scores. Nd:YAG laser may be better suitable for both sexes with minimal side effects. The limitation of this study is the smaller subject group and limited session.
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This article explores the intricacies of laser surgery, acknowledging inherent risks and complications. Patients with higher Fitzpatrick phototypes, characterized by unique biological traits, face heightened vulnerability during laser treatments. Limited experience with darker skin tones necessitates a higher level of laser expertise and a conservative approach. The study aims to comprehensively review laser therapy's side effects and complications, with a specific focus on Fitzpatrick phototypes IV through VI. We searched the MEDLINE database from 1972 to 2023 to consolidate knowledge. Results illuminate nuanced challenges associated with laser surgery in higher phototypes. In conclusion, this research emphasizes the need for enhanced expertise and caution in laser procedures for individuals with darker skin, offering valuable insights to optimize patient safety and outcomes.
Article
Unwanted hair is a common concern among patients presenting to pediatric dermatology clinics, and parents and patients alike inquire about the safety of methods employed for elective removal. Various methods of hair removal exist with different levels of invasiveness and permanence, from simple mechanical depilation to light-based therapies. All methods of hair removal appear to be safe and generally well tolerated in children, and there are no age restrictions to any modality. In this review, we aim to address the available literature on the safety and efficacy of hair removal modalities in pediatric patients and propose guidance on how to manage requests for at-home and in-office therapies within an ethical framework.
Article
Background: Laser hair removal is an increasingly prevalent trend of cosmetic procedures. The purpose of this study was to assess the effectiveness of hair reduction among several types of laser interventions. Methods: The selected studies searched in PubMed and EMBASE were assessed for quality of evidence, and extracted data on absolute hair count and hair reduction rate. Qualitative data were synthesized using standardized mean difference (SMD) in frequentist network meta-analysis because various measurement units were used among selected studies. Inconsistency and small study effects were examined by design-by-treatment interaction model and comparison-adjusted funnel plot. Results: A total of 13 randomized controlled trials (RCTs) (n = 652) were contributed to network meta-analysis. Pooled results revealed that diode laser showed significantly lower absolute hair count within three-month (SMD = -13.21, 95% confidence interval [CI]: -22.25 to -4.17) and around six months follow-up (SMD = -11.01, 95% CI: -18.24 to -3.77) as compared with those in control group, but no significant difference among laser interventions. All side effects observed were transient without leaving any permanent scars. Conclusion: Eliminating unwanted hair with lasers or intense pulsed light is safe and effective; however, which type of intervention is more beneficial in the long-term process should be studied with a longer follow-up time.
Article
Zusammenfassung Die Fotoepilation zählt zu den meistgefragten nichtchirurgischen Eingriffen in der ästhetischen Dermatologie. Haarlose, glatte Beine gelten dabei als Schönheitsideal. Fotoepilation mittels Laser oder hochenergetischer Blitzlampen (sog. Intensed-Pulsed-Light-Geräte) stellt ein sicheres und effektives Verfahren dar. Der Wirkmechanismus beruht auf dem Prinzip der selektiven Fotothermolyse, wobei eine gezielte thermische Schädigung pigmentierter Haarfollikel unter Schonung des umliegenden Gewebes erfolgt. Melaninpigment des Haarschaftes absorbiert als Zielchromophor Licht eines speziellen Wellenlängenspektrums und führt durch Wärmediffusion zur Schädigung der für das Haarwachstum wichtigen Stammzellen im äußeren Haarwurzelschaft. Patienten müssen über die Notwendigkeit wiederholter Behandlungen sowie den häufig nur partiellen und temporären Haarverlust aufgeklärt werden. Dunkle Terminalhaare bei hellen Hauttypen lassen sich effektiv entfernen. Bei dunklen Hauttypen besteht aufgrund des erhöhten epidermalen Melaninvorkommens ein erhöhtes Risiko für Nebenwirkungen wie Verbrennungen, Dyspigmentierungen und Narben. Sehr feine, helle oder rote Haare lassen sich kaum mit konventionellen Fotoepilationsverfahren entfernen. Haarentfernungsgeräte für den Heimgebrauch sind eine kostengünstige, einfach anzuwendende Alternative, weisen aber im Vergleich zur professionellen Fotoepilation eine geringere Effektivität auf.
Article
Unwanted facial hair growth is a common esthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation. The theory of selective photothermolysis has revolutionized laser hair removal in that it is effective and safe, when operated by sufficiently trained and experienced professionals. Long-pulsed ruby (694 nm), long-pulsed alexandrite (755 nm), diode (800–980 nm), and long-pulsed Nd: YAG (1064) are commercially available laser devices for hair removal most widely studied. The authors wish to share the efficacy and safety of intense pulse light therapy for permanent facial hair reduction in Indian population.
Article
Becker's nevus (BN) clinically presents as brown patches with hypertrichosis. The risk of pigmentary changes still remains a concern when using lasers to treat Asian patients with BN. We aimed to evaluate the outcomes on reduction of hairs and pigment of BN using the long-pulsed 1064-nm Nd:YAG (LPNY) and/or 755-nm alexandrite (LP-Alex), before treating pigment in earnest. A total of 13 subjects were treated with the LPNY (n = 8), the LP-Alex (n = 4), and both (n = 1). Improvements on hair removal and pigment reduction were assessed using a 5-point global assessment scale. Patient satisfaction was also assessed. Treatment parameters were within those commonly used for the purpose of epilation. The average follow-up period was 19.5 ± 12.3 weeks, and the mean total number of sessions was 2.0. Eleven subjects reported >50% improvement in hair removal (11/13, 86.7%), and pigment reduction of >50% improvement was observed in 9 subjects (9/13, 69.2%). Patient satisfaction showed >50% lesion clearance in 84.6%. Hair removal settings of LPNY and LP-Alex were effective in both hypertrichosis and pigment reduction in the initial strategy of treatment of BN in skin of color.
Article
Drugs are substances that exert effects in the body in order to alter an existing physiological or biochemical process. There are several methods of administering drugs, including the use of creams, ointments, liquids, skin patches, capsules, and injections. This column aims to highlight some of the drugs commonly utilized in dermatology. More precisely, this column hopes to better inform readers about the mechanism of action, administration, dosage, adverse effects, and possible alternatives for each particular drug discussed. This article highlights the use of eflornithine as a topical treatment for hirsutism.
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The American Society for Aesthetic Plastic Surgery estimates that in 2015 more than 1,200,000 laser hair-removal treatments were performed in the USA. Laser hair removal is currently the third most requested treatment in dermatology/aesthetic medicine. The effectiveness of photoepilation was first illustrated in 1996 by a group of researchers from Massachusetts General Hospital, who, with partial results, used light pulses generated by a ruby laser. In this chapter, we illustrate which are the best indications of hair removal, and we detailed different laser systems.
Chapter
Intense polychromatic lights are mainly used in medicine for vascular lesions, hyperpigmentation, and hair removal. They are broadband flashlamps that emit polychromatic incoherent light ranging from visible to infrared. Cutoff optical filters are used to select light bands for specific indications. Differently from lasers that have single wavelengths, intense polychromatic lights can reach multiple chromophores such as melanin, hemoglobin, water, and collagen within the same exposure.
Article
Light‐based therapies are one of the most effective and widely used strategies for removal of undesired hair, with a broadly favorable safety profile. However, subjects with pigmented skin are found to be more prone to laser‐related adverse events. While prolonged pulse‐width and longer treatment duration were proposed to minimize adverse events, the optimal treatment option among available phototherapy modalities—long‐pulsed (Nd: YAG), pulsed diode, and alexandrite lasers as well as intense pulsed light (IPL)—remains unclear, particularly for skin of color. To determine superiority in terms of effectiveness and tolerability, we conducted a systematic review of literature on different types of in‐office laser and IPL for hair removal in subjects with Fitzpatrick skin types III‐VI. The meta‐analysis was performed using Review Manager (RevMan) version 5.3 and included 12 eligible comparative trials (9 randomized controlled trials and 3 quasi‐randomized). In terms of hair count reduction, pooled effect estimates for long‐pulsed ND:YAG laser (OR 0.26, 95% CI [0.1, 0.78]) and diode laser (SMD ‐0.11, 95% CI [‐0.62, 0.39) were not statistically significant from those of IPL; in contrast, alexandrite laser was found to be superior to IPL in reducing hair count (SMD ‐1.7, 95% CI [‐2.6, ‐0.78]. In terms of adverse events, the pooled effect estimates favoured long‐pulsed Nd: YAG laser to IPL with respect to post‐inflammatory hyperpigmentation (OR 0.26, 95% CI [0.1, 0.78]). However, both pulsed diode and alexandrite lasers exhibited a comparable safety profile to IPL, despite higher pain scores with lasers. In conclusion, this systematic review suggests that treatment outcomes for different in‐office laser devices and IPL in subjects with skin type III‐VI are broadly similar; nevertheless, we observed a trend toward greater hair reduction following laser therapy compared to IPL.
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Lasers for hair removal are a fast-growing area in cosmetic dermatology. Selective photothermolysis allows for targeting of specific chromophores while minimizing cutaneous damage. Treatment of individuals should be individualized based on anatomical area, skin and hair color, by varying the wavelength, fluence, pulse duration, spot size, and cooling technique of the laser.
Article
Unwanted facial and body hair presents as a common finding in many patients, such as females with hirsutism. With advances in laser and light technology, a clinically significant reduction in hair can be achieved in patients with light skin. However, in patients with darker skin, Fitzpatrick skin types (FST) IV–VI, the higher melanin content of the skin interferes with the proposed mechanism of laser-induced selective photothermolysis, which is to target the melanin in the hair follicle to cause permanent destruction of hair bulge stem cells. Many prospective and retrospective studies have been conducted with laser and light hair-removal devices, but most exclude patients with darkly pigmented skin, considering them a high-risk group for unwanted side effects, including pigmentation changes, blisters, and crust formation. We reviewed the published literature to obtain studies that focused on hair reduction for darker skin types. The existing literature for this patient population identifies longer wavelengths as a key element of the treatment protocol and indicates neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, alexandrite, and ruby lasers as well as certain intense pulsed light sources for safe hair reduction with minimal side effects in patients with FST IV–VI, so long as energy settings and wavelengths are appropriate. Based on the findings in this review, safe and effective hair reduction for patients with FST IV–VI is achievable under proper treatment protocols and energy settings.
Article
Background: Photothermal destruction of hair shaft melanin with intense pulsed light (IPL) and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has become an effective treatment of hair removal. Aims: Our aim was to compare efficacy, satisfactory levels, safety, and side effects of Nd:YAG and IPL in hair reduction. Methods: This was a prospective randomized intrapatient, right-left, assessor-blinded comparison of Nd:YAG vs IPL. There were 38 volunteers recruited. Seven sessions were performed. Hair count, efficacy, and side effects were compared before and after each treatment and 6 months after the last treatment. In respect of 12 volunteers, we have examined the reduction in hair after 18 months. Results: Initially, there was no significant difference between the numbers of hair follicles. There was significant hair reduction after each treatment on the Nd:YAG-treated side. The hair reduction became significant after the third treatment with IPL. Comparison of the efficacy of the two devices on each visits showed no significant difference. There was statistically lower pain score on the IPL-treated side and statistically higher erythema, burning sensation, and edema on the Nd:YAG-treated side. Statistically lower side effect score was observed on the IPL-treated side. Eight months after the last treatment, there was significant hair reduction both on the Nd:YAG and on the IPL-treated side, and there was no difference between the efficacy. The patient satisfaction scores were higher with the IPL. Conclusion: Unwanted hair can be reduced by both systems safely and effectively; however, IPL has less side effects and higher satisfaction scores.
Chapter
Lasers for the removal of unwanted hair, using selective destruction of the hair follicle without damage to adjacent tissues, are a common procedure in the dermatologist’s practice. The diode laser, neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser, ruby laser, alexandrite laser, and intense pulsed light are some of the technologies available today for long-term hair removal. Proper selection of the wavelength, pulse duration, and fluence is crucial to the success and safety of the procedure. Treatment performed with laser and other light sources usually produces a complete temporary hair loss, followed by partial permanent hair removal. The patient’s phototype and hair color must be carefully evaluated as well as the presence of tanning, since the presence of epidermal melanin increases the risks and decreases the effectiveness of the procedure. The ideal patient for laser or IPL hair removal is the one with low skin phototype and dark hair. There is currently no consensus regarding the number of treatment sessions and the interval between them. Its determination must take into consideration the individual characteristics of hair growth, the body area, and the type of light source used. The most common complications are hyper- or hypopigmentation, which is temporary in most cases, but there are reports of permanent changes. In general, laser treatment for hair removal is considered to be both safe and effective.
Article
Androgen excess (AE) is a key feature of polycystic ovary syndrome (PCOS) and results in or contributes to the clinical phenotype of these patients. While AE will contribute to the ovulatory and menstrual dysfunction of these patients the most recognizable sign of AE includes hirsutism, acne and androgenic alopecia or female pattern hair loss (FPHL). Evaluation not includes scoring facial and body terminal hair growth using the modified Ferriman-Gallwey method, but also recording and possibly scoring acne and alopecia. Assessment of biochemical hyperandrogenism is also necessary, particularly in patients with unclear or absent hirsutism, and will include assessing total and free testosterone (T), and possibly DHEAS and androstenedione, although these latter add a limited amount to the diagnosis. Assessment of T requires use of the highest quality assays available, generally radioimmunoassays with extraction and chromatography, or mass spectrometry preceded by liquid or gas chromatography. Management of clinical hyperandrogenism involves primarily either androgen suppression, with a hormonal combination contraceptive, or androgen blockade, as with an androgen receptor blocker or a 5α-reductase inhibitor, or a combination of the above. Medical treatment should be combined with cosmetic treatment including the use of topical eflornithine hydrochloride, and short-term (shaving, chemical depilation, plucking, threading, waxing, and bleaching) and long-term (electrolysis, laser therapy, and intense pulse light therapy) mechanical treatments. Generally acne responds to therapy relatively rapidly, while hirsutism is slower to respond, with improvements observed as early as three months, but generally only after 6 or 8 months of therapy. Finally, FHLP is the slowest to respond to therapy, if it will at all, and it may take 12 to 18 months of therapy before response is begun to be observed.
Article
Intense pulsed light (IPL) devices use incoherent high-intensity pulsed light of 400-1200 nm wavelength spectrum. Indication and adverse reactions of IPL systems are similar to lasers. IPL systems can be used for epilation, telengiectasia, pigmentation and photoaging therapy. The most side effects due to IPLs are burning and pain on the skin, bulla formation, hipo and hyper pigmentation. IPL devices have advantages for wide lesions with large spot size, and they can be used for darker color skin with less side effect. Comparison of IPL devices is very difficult, since a large number of different IPL devices are available.
Article
Resumen Los sistemas de luz pulsada intensa han evolucionado desde su introducción en la medicina hace 20 años. La luz pulsada consiste en una energía lumínica policromática, no coherente y no colimada que abarca varias longitudes de onda pudiendo actuar sobre diferentes cromóforos. Este hecho permite una gran versatilidad, pudiendo tratar diferentes enfermedades, desde lesiones pigmentadas o vasculares hasta fotodepilación y fotorrejuvenecimiento, con una alta tasa de cobertura de la piel gracias al gran tamaño del haz. Al tratarse de sistemas no ablativos resulta una opción en auge actualmente, ya que los pacientes no están dispuestos a asumir los efectos secundarios de otros procedimientos que además requieren tiempos prolongados de ausencia de la vida laboral y social. Su eficacia es similar en muchos casos a los tratamientos con láser. El abanico de posibilidades y aplicaciones se incrementará en los próximos años gracias a esa gran versatilidad junto a la comodidad y seguridad.
Article
Background: Devices such as diode laser and intense pulsed light (IPL) are in constant development aiming at permanent hair removal, but there are few comparative studies between these technologies. Objective: The objective was to comparatively assess axillary hair removal performed by diode laser and IPL and to obtain parameters of referred pain and evolution response for each method. Materials and methods: A comparative prospective, double-blind, and randomized study of axillary hair removal performed by the diode laser and IPL was conducted in 21 females. Six sessions were held with application of the diode laser in one axilla and the IPL in the other, with intervals of 30 days and follow-up of 6 months after the last session. Clinical photographs and digital dermoscopy for hair counts in predefined and fixed fields of the treated areas were performed before, 2 weeks after the sixth session, and 6 months after the end of treatment. A questionnaire to assess the pain was applied. Results: The number of hair shafts was significantly reduced with the diode laser and IPL. The diode laser was more effective, although more painful than the IPL. No serious, adverse, or permanent effects were observed with both technologies. Conclusion: Both diode laser and the IPL are effective, safe, and able to produce lasting results in axillary hair removal.
Article
Facial resurfacing procedures are becoming increasingly popular. The percentage of non-Caucasian individuals seeking these treatments continues to rise. Patients with darker skin types (Fitzpatrick skin types IV-VI) face unique challenges for successful facial skin resurfacing. Common issues encountered by non-Caucasian patients include dyschromias, acne scars, photoaging, keloid and hypertrophic scars, benign cutaneous tumors, and hair-related disorders. This article discusses the most frequently used lasers and chemical peels used to address these problems.
Article
Part two of this review series evaluates the use of lasers and laser-like devices in dermatology based on published evidence and the collective experience of the senior authors. Dermatologists can laser-treat a wide range of dermatoses, including vascular, pigmentary, textural, benign proliferative and premalignant conditions. Some of these conditions include vascular malformation, haemangioma, facial telangiectases, café-au-lait macules, naevi of Ota, lentigines, acne scarring, rhytides, rhinophyma and miscellaneous skin lesions. Photodynamic therapy with lasers and intense pulsed light is addressed, with particular reference to actinic keratosis and actinic cheilitis. A treatment algorithm for acne scarring based on scar morphology and severity is comprehensively outlined. Following from part one, the various devices are matched to the corresponding dermatological conditions with representative pictorial case vignettes illustrating likely clinical outcomes as well as limitations and potential complications of the various laser and light therapies.
Article
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To examine the clinical, histological, and immunohistological effects of flashlamp photoepilation. Nonrandomized control trial with blinded histological study and follow-up of 1 to 20 months. Private academic practice. Sixty-seven subjects (10 males and 57 females) with areas of excess body hair. Single (9 subjects) or multiple (58 subjects) treatments (noncoherent, 590-1200 nm, 2.9-3.0 milliseconds, 40-42 J/cm2) to hairy skin. From subjects given a single treatment, biopsy samples were taken immediately after treatment and at different intervals for up to 20 months. Clinical measures include hair counts and morphologic features before and after treatment. Histological measures include terminal-vellus and anagen-other ratios, hair shaft diameter, and morphologic features (routine and immunohistochemical detection of bcl-2, bax, p53, Ki67, cyclin D1, and hsp70) before and after treatment. Mean hair loss after photoepilation was 49%, 57%, and 54% for a single treatment and 47%, 56%, and 64% for multiple treatments at follow-up of less than 3 months, 3 to less than 6 months, and 6 months or longer, respectively (P<.05 for all comparisons). Transient erythema was seen in all subjects; no scarring occurred. Histologically, treatment caused morphologic damage confined to hair follicles and shafts. Terminal-vellus and anagen-telogen ratios, mean hair shaft diameter, and immunohistochemical profiles were not significantly modified by treatment. Treatment did not alter other skin adnexa, epidermis, or vessels. Flashlamp treatment leads to significant, longlasting epilation. The predominant mechanism seems to be via selective photothermal damage to large, pigmented hair follicles rather than induction of a programmed state of follicular cycle arrest or follicular miniaturization.
Article
Full-text available
The main purpose of this clinical study was to compare the effectiveness of an intense pulsed light irradiator system (IPL) and a normal mode ruby laser for hair removal. Thirty-one patients were treated 3 times with a new IPL system on one side of the chin and neck and with a normal mode ruby laser on the other side. After 6 months, nine of the patients received 3 additional IPL treatments and 11 patients received 3 additional ruby laser treatments. All treatment intervals were 2 months. Hair reduction was measured by hair counts on close-up photographs. Hair reduction was obtained by 93.5% of the patients after 3 IPL treatments and by 54.8% after 3 ruby laser treatments. The average hair count was reduced by 49.3% after IPL treatments and by 21.3% after ruby laser treatments. Three additional IPL treatments following 3 IPL treatments resulted in only 6.6% further hair reduction--in total 55.9%, whereas 3 IPL treatments following 3 ruby laser treatments resulted in an additional 35.5% hair reduction--in total 56.8%. The IPL was found to be 3.94 times more effective than the ruby laser for hair removal. In the chin and neck region, more than 3 treatments with the IPL did not improve the therapeutic result significantly.
Article
Full-text available
To determine the safety and effectiveness of a long-pulsed Nd:YAG laser at 1064 nm in effecting long-term hair reduction in patients with darkly pigmented skin. Nonrandomized before-after clinical and histological trial. Private practice, ambulatory care facility. Twenty women with skin phototypes IV through VI and dark brown to black terminal hair on the face, axillae, or legs. A series of 3 long-pulsed (50-millisecond) 1064-nm Nd:YAG laser treatments at fluences ranging from 40 to 50 J/cm(2) were delivered to the identified treatment areas on a monthly basis by a single operator. Global clinical grading scores of comparable before-after treatment photographs were determined by 2 independent medical assessors during each laser session and 1, 3, 6, and 12 months postoperatively. A dermatopathologist reviewed unmarked histological specimens obtained at baseline, immediately after the initial laser treatment, and at 1 and 6 months after the final laser session. Substantial hair reduction was seen after each of the 3 treatment sessions. Prolonged hair loss was observed 12 months after the final laser treatment (70%-90% hair reduction). Axillary hair was substantially more responsive to laser irradiation than was hair located on the legs and face. Adverse effects included mild to moderate treatment pain and rare occurrences of vesiculation and transient pigmentary alteration without fibrosis or scarring. Histological tissue changes mirrored clinical response rates, with evidence of selective follicular injury without epidermal disruption. The long-pulsed 1064-nm Nd:YAG laser is a safe and effective method of long-term hair reduction in patients with darkly pigmented skin.
Article
Laser-assisted hair removal is the most efficient method of long-term hair removal currently available. Several hair removal systems have been shown to be effective in this setting: ruby laser (694nm), alexandrite laser (755nm), diode laser (800nm), intense pulsed light source (590 to 1200nm) and the neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1064nm), with or without the application of carbon suspension. The parameters used with each laser system vary considerably. All these lasers work on the principle of selective photothermolysis, with the melanin in the hair follicles as the chromophobe. Regardless of the type of laser used multiple treatments are necessary to achieve satisfactory results. Hair clearance, after repeated treatments, of 30 to 50% is generally reported 6 months after the last treatment. Patients with dark colored skin (Fitzpatrick IV and V) can be treated effectively with comparable morbidity to those with lighter colored skin. Although there is no obvious advantage of one laser system over another in terms of treatment outcome (except the Nd:YAG laser, which is found to be less efficacious, but more suited to patients with darker colored skin), laser parameters may be important when choosing the ideal laser for a patient. Adverse effects reported after laser-assisted hair removal include erythema and perifollicular edema, which are common, and crusting and vesiculation of treatment site, hypopigmentation and hyperpigmentation (depending on skin color and other factors). Most complications are generally temporary. The occurrence of hypopigmentation after laser irradiation is thought to be related to the suppression of melanogenesis in the epidermis (which is reversible), rather than the destruction of melanocytes. Methods to reduce the incidence of adverse effects include lightening of the skin and sun avoidance prior to laser treatment, cooling of the skin during treatment, and sun avoidance and protection after treatment. Proper patient selection and tailoring of the fluence used to the patient’s skin type remain the most important factors in efficacious and well tolerated laser treatment. While it is generally believed that hair follicles are more responsive to treatment while they are in the growing (anagen) phase, conflicting results have also been reported. There is also no consensus on the most favorable treatment sites.
Article
Applications for intense pulsed light (IPL) for hair removal are gaining favor among other methods, including lasers, because of its noninvasive nature, versatility regarding different skin and hair types, safety, and ease of use. Hair removal using IPL was performed from January 2002 to December 2003 on 108 consecutive patients. Eighty of these patients answered a questionnaire and were enrolled in the study group. The investigated parameters were hair and skin type, number of pulses, fluence, pulse duration, pulse delay, the filters used, and the treated area. The patient assessment of improvement (satisfaction) rate was graded from 1 to 5 points: 1, worse; 2, no improvement; 3, mild improvement; 4, good result; and 5, excellent result. The patients had between 1 and 13 treatments most of them during 2 to 6 sessions. Sixty-seven percent of the patients reported no complications. Prolonged erythema for more than 7 days was reported by 16.25%, blisters by 6.25%, temporary hyperpigmentation by 8.75%, leukotrichia was present in 1 case, and I case of persistent hypopigmentation was noted in a young girl. An increased number of complications and a decreased satisfaction rate were noted with higher skin types, but it was not statistically significant. Patients who underwent fewer treatments (1-3 treatments) were more satisfied compared with those who had more than 7 treatments (P < 0.02). Sixty percent of the patients rated their satisfaction to be good to excellent and 65% would ill recommend this treatment to their friends. To minimize the complication rate the authors found that the preset parameters should be adjusted at every treatment session according to the skin response at the previous one. Permanent hair removal cannot be guaranteed and it is not possible to predict the improvement rate. Nevertheless, based on patient satisfaction rate in this study, the authors recommend using IPL for hair removal.
Article
Background. Lasers with long wavelengths are less well absorbed by melanin and are considered to be particularly suitable for hair removal in dark-skinned patients.Objective. To compare the efficacy and complications of 800 nm diode and long-pulsed 1064 nm Nd:YAG lasers in laser-assisted hair removal in Chinese patients.Methods. Fifteen women had hair removal treatments (13 axillae and 2 legs) with diode laser on one side and Nd:YAG laser on the other. They were followed up for 36 weeks. Subjective assessments included the degree of immediate pain and the degree of hair regrowth. Clinical photographs were taken for evaluation by two independent observers to assess complications and the degree of hair regrowth.Results. Long-pulsed Nd:YAG laser was found to be significantly associated with a greater degree of immediate pain after laser surgery (P = .0001, independent sample t-test) and also had a longer laser time (P = .0001, independent sample t-test). Besides transit adverse effects such as erythema and perifollicular edema, only one patient developed hypopigmentation at week 6 which resolved by week 36. Although regrowth rates were low at week 6 (subjective rates were 23% and 19% for Nd:YAG and diode laser, respectively), most patients had significant regrowth at week 36 (subjective regrowth rate 91% for both long-pulsed Nd:YAG and diode lasers).Conclusion. Diode 800 nm and Nd:YAG 1064 nm lasers are safe in laser-assisted hair removal in Chinese patients, and besides immediate pain, there was no other significant adverse effect. Most patients experienced regrowth 36 weeks after a single treatment. Further study is necessary to determine the long-term clinical efficacy and complications of laser-assisted hair removal with these systems in dark-skinned patients.
Article
A systematic and logical approach for laser hair removal demands an understanding of its biologic and physical bases. This article presents an overview of hair anatomy and physiology followed by a mathematically nonrigorous review of tissue optics and thermal responses to laser irradiation. The reader is provided with a step by step approach to laser hair removal.
Article
The ruby laser is effective in removing unwanted body hair. The occurrence of cutaneous side-effects such as blistering, hypopigmentation and hyperpigmentation, however, remains problematic. These side-effects are more commonly seen in patients with dark coloured skin, which partly explains the relative scarcity of information on the efficacy of ruby laser hair removal in such patients. The mechanisms of the occurrence of these side-effects are also not known. It was the aim of this study to evaluate the efficacy of ruby laser-assisted hair removal in patients with Fitzpatrick skin type V in a retrospective clinical study and to evaluate the mechanism of post-treatment pigmentary change in a prospective clinical study. The percentage reduction in hair density in patients with skin type V was assessed after a variable period following treatment with the Chromos 694 Depilation Ruby Laser, and was compared with the results of those with skin types I-IV. To study the pigmentary change and melanocyte numbers after laser irradiation, ex-vivo scalp skin and serial patient biopsies were taken and stained with S-100, dopa oxidase and Masson-Fontana methods. Laser treatment reduced melanocyte numbers as measured by DOPA stain but not by S100. Laser treatment resulted in the clearance of pigment from the epidermis on histology. Ruby laser was shown to be effective in removing unwanted hair from patients with dark coloured skin, but with a higher incidence of cutaneous side-effects. The occurrence of hypopigmentation after laser irradiation was thought to be due to the suppression of melanogenesis in the epidermis rather than to destruction of the melanocytes.
Article
The goal of laser or flashlamp photoepilation is to produce long-term, cosmetically significant hair removal. We document the long-term efficacy achieved with an intense pulsed light source for photoepilation. Prospective study comparing long-term results of single vs multiple treatments, and effects of anatomic site and skin type on efficacy of photoepilation with a device emitting broad-spectrum, noncoherent (nonlaser) radiation from 550- to 1200-nm wavelengths, in macropulses divided into 2 to 5 minipulses. Private dermatology practice. Thirty-four patients (8 men, 26 women) with hirsutism. Parameters for the study were wavelength of 615 to 695 nm, pulse duration of 2.6 to 3.3 milliseconds, fluence of 34 to 42 J/cm(2), 10 x 45-mm exposure field, and application of 1 degrees C cooling gel. Hair removal efficiency, calculated as percentage ratio of the number of hairs present compared with baseline counts, and patient satisfaction questionnaire completed at last follow-up. The mean hair removal efficiency achieved was 76% after a mean of 3.7 treatments. More than 94% of the sites reached mean hair removal efficiency values greater than 50%. Hair removal efficiency was not significantly related to skin type, hair color, anatomic site, or number of treatments. Side effects were mild and reversible and occurred in a minority of patients (hyperpigmentation in 3 and superficial crusting in 2). Our data document the long-term clinical efficacy of intense pulsed light source-induced hair removal in light and dark skin phenotypes. Maximal photoepilation was achieved from the initial 1 to 3 treatments; only a small added benefit was seen after more treatments.
Article
There is an increasing demand for safe and efficient hair removal. Although long-term hair removal has been demonstrated using lasers and non-coherent light sources, permanent hair removal has been difficult to claim due to the long growth/rest cycle of normal human hair follicles. To evaluate bikini line hair removal with a second generation intense pulsed light (IPL) source. Ten females (20 bikini lines) with dark hair and skin types II-IV were treated with an IPL (600 nm) four times with a 1-month interval. Counting of the hair follicles was carried out with a computer imaging system before treatment, and 4 and 8 months after the treatments. Hair reduction of 74.7% (SD +/- 18.3%) was seen 4 months after the treatments and 80.2% (SD +/- 20.3%) 8 months after the last treatment. Only minimal side effects were noted and no pain or other discomfort was registered during the treatments. The present study demonstrated that this new IPL system is both efficient and safe for hair removal. Because the follow up period of 8 months is twice the cycle time for hairs in the bikini line area, the obtained hair reduction in this study was long-lasting.
Article
Lasers with long wavelengths are less well absorbed by melanin and are considered to be particularly suitable for hair removal in dark-skinned patients. To compare the efficacy and complications of 800 nm diode and long-pulsed 1064 nm Nd:YAG lasers in laser-assisted hair removal in Chinese patients. Fifteen women had hair removal treatments (13 axillae and 2 legs) with diode laser on one side and Nd:YAG laser on the other. They were followed up for 36 weeks. Subjective assessments included the degree of immediate pain and the degree of hair regrowth. Clinical photographs were taken for evaluation by two independent observers to assess complications and the degree of hair regrowth. Long-pulsed Nd:YAG laser was found to be significantly associated with a greater degree of immediate pain after laser surgery (P =.0001, independent sample t-test) and also had a longer laser time (P =.0001, independent sample t-test). Besides transit adverse effects such as erythema and perifollicular edema, only one patient developed hypopigmentation at week 6 which resolved by week 36. Although regrowth rates were low at week 6 (subjective rates were 23% and 19% for Nd:YAG and diode laser, respectively), most patients had significant regrowth at week 36 (subjective regrowth rate 91% for both long-pulsed Nd:YAG and diode lasers). Diode 800 nm and Nd:YAG 1064 nm lasers are safe in laser-assisted hair removal in Chinese patients, and besides immediate pain, there was no other significant adverse effect. Most patients experienced regrowth 36 weeks after a single treatment. Further study is necessary to determine the long-term clinical efficacy and complications of laser-assisted hair removal with these systems in dark-skinned patients.
Article
Laser and flash-lamp technology now offers the potential for rapid, safe, and effective treatment of unwanted hair. An ever-increasing number of published studies have confirmed the long-term efficacy of laser and flash-lamp treatment. The benefits of this technology have largely been limited to individuals with dark hair and relatively fair skin. The first studies using devices with a combination of longer wavelengths, longer pulse durations, and adequate epidermal cooling have shown that it is possible to safely and effectively treat individuals with darker skin types. The remaining challenge is to develop the means to eliminate light-colored hair as well. The increasing consumer demand for low-cost hair removal has driven the development of low-cost hair removal devices, such as small, pulsed flash lamps. The rapid pace of technologic advances and continued studies of hair follicle biology promise to improve this field over the years to come. In the future, small, low-cost laser-razors may replace all other means of hair removal.
Article
Laser-assisted hair removal is the most efficient method of long-term hair removal currently available. Several hair removal systems have been shown to be effective in this setting: ruby laser (694nm), alexandrite laser (755nm), diode laser (800nm), intense pulsed light source (590 to 1200nm) and the neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1064nm), with or without the application of carbon suspension. The parameters used with each laser system vary considerably. All these lasers work on the principle of selective photothermolysis, with the melanin in the hair follicles as the chromophobe. Regardless of the type of laser used multiple treatments are necessary to achieve satisfactory results. Hair clearance, after repeated treatments, of 30 to 50% is generally reported 6 months after the last treatment. Patients with dark colored skin (Fitzpatrick IV and V) can be treated effectively with comparable morbidity to those with lighter colored skin. Although there is no obvious advantage of one laser system over another in terms of treatment outcome (except the Nd:YAG laser, which is found to be less efficacious, but more suited to patients with darker colored skin), laser parameters may be important when choosing the ideal laser for a patient. Adverse effects reported after laser-assisted hair removal include erythema and perifollicular edema, which are common, and crusting and vesiculation of treatment site, hypopigmentation and hyperpigmentation (depending on skin color and other factors). Most complications are generally temporary. The occurrence of hypopigmentation after laser irradiation is thought to be related to the suppression of melanogenesis in the epidermis (which is reversible), rather than the destruction of melanocytes. Methods to reduce the incidence of adverse effects include lightening of the skin and sun avoidance prior to laser treatment, cooling of the skin during treatment, and sun avoidance and protection after treatment. Proper patient selection and tailoring of the fluence used to the patient's skin type remain the most important factors in efficacious and well tolerated laser treatment. While it is generally believed that hair follicles are more responsive to treatment while they are in the growing (anagen) phase, conflicting results have also been reported. There is also no consensus on the most favorable treatment sites.
Article
Laser surgery for Asians differs from that for Caucasians in several important respects. In Asians, some conditions such as nevus of Ota are frequently seen and certain adverse reactions, especially postinflammatory hyperpigmentation, tend to be more common. This article reviews the use of different types of lasers and intense pulsed light (IPL) sources for the treatment of Asian patients. Various cutaneous conditions amenable to laser treatment, including lentigines, nevus of Ota, acquired bilateral nevus of Ota-like macules, port-wine stains, and acne scarring, are discussed. Strategies for the management of postinflammatory hyperpigmentation are offered. Appropriate selection and careful planning of the treatment can lead to excellent clinical outcome. Lasers and intense pulsed light sources are important tools for the treatment of a wide range of cutaneous conditions in Asians.
Article
Pseudofolliculitis barbae affects a large number of individuals with coarse curly hair, and present treatment options are suboptimal. We evaluated the safety and efficacy of a long-pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser in the treatment of pseudofolliculitis barbae. This was a two-phase observational study conducted at a military tertiary medical facility. The study group included 37 patients (skin types IV, V, and VI) referred from primary care physicians with a diagnosis of pseudofolliculitis barbae refractory to conservative therapy. In phase I, one treatment with a Nd:YAG laser was performed on a tattooed area of the thigh with 3 light doses. Epidermal tolerance was evaluated, and hair counts were performed 3 months after treatment for each light dose. In phase II, the highest dose tolerated by the epidermis from phase I was applied to a small submental region of skin with an adjacent site as a control. Subsequently, papule counts were performed 90 days after treatment in the laser-irradiated and control areas. Phase I: When normalized for controls, there was 33%, 43%, and 40% hair reduction on the thigh for the 50, 80, and 100 J/cm(2) fluences, respectively, after 90 days. Overall, the highest doses tolerated by the epidermis were 50, 100, and 100 J/cm(2) for type VI, V, and IV skin, respectively. Phase II: Mean papule counts after 90 days were 6.95 and 1.0 for the control and treatment sites, respectively. Nd:YAG laser treatment may represent a safe and effective option for reducing hair and subsequent papule formation in patients with pseudofolliculitis barbae.
Article
Lasers permit treatment of unwanted excess hair with less discomfort than other methods of epilation. Many lasers with different parameters are now available from which the dermatologist can choose. Improved clinical results are made possible by the high specificity and selectivity of the laser systems to pigmented hair because of the use of an appropriate wavelength with the proper pulse and duration. We aimed to compare the results of treatment of skin types IV, V, and VI using three different laser systems. One hundred female patients were compared using different laser systems: 35 patients underwent epilation using a Nd-Yag laser, 33 patients using an Alexandrite laser, and 32 patients using a Diode laser. Follow up 12 months after the multiple treatments (three to six sessions) showed an insignificant difference between these three groups (35-40%). Our findings indicate that all three laser systems tested can be used for dark skin; however, one should select a system that minimizes side-effects, primarily hypo- and hyper-pigmentation, especially when used for skin types IV, V, and VI.
Article
To investigate the safety and effectiveness of a long pulsed Nd:YAG (1064nm) laser compared to a shorter wavelength intense pulse light system for assisted hair removal in volunteers with skin type 1V, V and VI. Eleven patients of Fitzpatrick skin type IV-VI were recruited into the study. The area treated included the face (upper lips, chin and jaw area), axillae and legs. One half of the body was treated with the long pulse Nd:YAG laser and the other half was treated with the IPL system randomly under topical anesthesia. Degree of pain experienced during treatment, the treatment outcome and any complications were observed. Patients were reviewed at 2 weeks and 6 weeks post-treatment. Volunteers generally described pain from the IPL system as "prolonged burning sensation" but tolerable. Pain from Nd:YAG laser treatment was described as "pinprick" and more intense but tolerable. "Slowing of hair growth"was reported with IPL and Nd:YAG, but with a greater effect from Nd:YAG. Sixty-four percent and 73%(8/11) noticed hair reduction <20% after 6 weeks on IPL and Nd:YAG treated side respectively (ns). Post-inflammatory pigmentation occurred in some volunteers on the IPL treated sides whereas this was not seen on any Nd:YAG treated side, and three of these patients experienced blistering, followed by post-inflammatory pigmentation. In our experience the long pulse width 1064 nm Nd:YAG laser, which can penetrate 5-7 mm into the dermis depths to reach the whole length of the hair follicle, would be expected to produce sufficient follicular injury with less epidermal damage in patients with darker skin type compared to shorter wavelength laser and light system.
Article
Although challenging, effective laser surgery in patients with darker skin tones can be achieved despite a higher inherent risk of untoward side effects. While the incidence of undesirable postoperative sequelae has decreased with the development of advanced laser technology and individualized treatment parameters, these risks may never be eliminated completely. Consequently, thorough patient preoperative preparation and education regarding the risks of cutaneous laser therapy will remain an essential component of treatment in darkly pigmented patients. In the future, as more refined laser techniques evolve, the ability to safely and effectively treat these patients will improve.
Article
Undesirable hair growth presents a significant problem for many patients, and photoepilation has become a very popular procedure in aesthetic and cosmetic practice. Among the systems used are the long- and short-pulsed alexandrite lasers (LP-Alex, SP-Alex) and intense pulsed light (IPL) sources. The present study retrospectively examined the outcome of these systems from the viewpoint of efficacy and side effects. Three hundred and eighty-nine patients (370 females and 19 males, mean age 36.4 yrs, skin types II-V) were admitted to the study, with a total of 532 treated sites. They were treated either with the LP-Alex, SP-Alex or IPL. Subjective evaluation and interview of the patients was held prior to every treatment session. Six to eight treatments were required with the alexandrite lasers, 2.4-2.8 months between treatments, and the IPL source required 8-9 treatments, 2-2.5 months apart. No significant difference was seen between the LP- and SP-Alex, or between both of them and the IPL source, although the period to regrowth was longer for the lasers. Erythema and oedema were more noticeable with the LP-Alex, as were crusting and hyper- and hypopigmentation. Discomfort was greatest with the LP-Alex and the IPL source. Hair induction at the borders of the treated area on the face and neck was seen only with the LP-Alex, and correlated statistically significantly with any episode of severe erythema, crusting or hyperpigmentation. There was no statistically significant difference between the LP-, SP-Alex and IPL photoepilation with regard to efficacy. Transient side effects were highest with the LP-Alex, and least with the IPL system. In the LP-Alex treated face and neck sites, 3.1% had hair induction in the borders of the treated areas.
Article
Before the advent of longer wavelengths, longer pulse durations and more efficient cooling devices, laser-assisted hair removal was best suited for phototypes I-III with dark terminal hairs. Now, laser-assisted hair removal can be performed safely and efficaciously on darker skin types. The long-pulsed diode and Nd:YAG-wavelength-based laser systems are best suited to safely and effectively treat patients with darker skin types. By using conservative fluences, longer pulse durations and multiple treatments, safe and effective laser-assisted hair removal is possible for darker skin types. Patients with darker skin who suffer from hirsutism, hypertrichosis, and pseudofolliculitis barbae can finally be treated safely and effectively.
Article
The use of light and laser for hair removal has evolved during the past few years. Laser systems such as the ruby laser (694 nm), alexandrite laser (755 nm), diode laser (810 nm) and neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1,064 nm) are commonly used in hair removal. However, permanent hair removal has been difficult to achieve using lasers owing to the long growth/rest cycle of normal human hair follicles. There is still an increasing demand for safer and more efficient hair removal techniques. The latest and most effective choice in the treatment of hair removal is non-coherent intense pulsed light (IPL), which is both efficient and safe for hair removal. A group of 210 patients with skin type III-V were treated for superfluous hair in different areas of the body (face, extremities, axillae, bikini line and back) for three to five sessions at 6-week intervals using IPL. There was a significant hair reduction of about 80% with no side effects and minimal complications. Follow-up was done 6 months after the last session. In conclusion, IPL is very effective and safe for hair removal.
Article
Applications for intense pulsed light (IPL) for hair removal are gaining favor among other methods, including lasers, because of its noninvasive nature, versatility regarding different skin and hair types, safety, and ease of use. Hair removal using IPL was performed from January 2002 to December 2003 on 108 consecutive patients. Eighty of these patients answered a questionnaire and were enrolled in the study group. The investigated parameters were hair and skin type, number of pulses, fluence, pulse duration, pulse delay, the filters used, and the treated area. The patient assessment of improvement (satisfaction) rate was graded from 1 to 5 points: 1, worse; 2, no improvement; 3, mild improvement; 4, good result; and 5, excellent result. The patients had between 1 and 13 treatments most of them during 2 to 6 sessions. Sixty-seven percent of the patients reported no complications. Prolonged erythema for more than 7 days was reported by 16.25%, blisters by 6.25%, temporary hyperpigmentation by 8.75%, leukotrichia was present in 1 case, and 1 case of persistent hypopigmentation was noted in a young girl. An increased number of complications and a decreased satisfaction rate were noted with higher skin types, but it was not statistically significant. Patients who underwent fewer treatments (1-3 treatments) were more satisfied compared with those who had more than 7 treatments (P < 0.02). Sixty percent of the patients rated their satisfaction to be good to excellent and 65% would ill recommend this treatment to their friends. To minimize the complication rate the authors found that the preset parameters should be adjusted at every treatment session according to the skin response at the previous one. Permanent hair removal cannot be guaranteed and it is not possible to predict the improvement rate. Nevertheless, based on patient satisfaction rate in this study, the authors recommend using IPL for hair removal.
Article
Unwanted hair growth remains a therapeutic challenge and there is a considerable need for an effective and safe treatment modality. From an evidence-based view to summarize efficacy and adverse effects from hair removal with ruby, alexandrite, diode, and Nd:YAG lasers and intense pulsed light (IPL). Original publications of controlled clinical trials were identified in Medline and the Cochrane Library. A total of 9 randomized controlled (RCTs) and 21 controlled trials (CTs) were identified. The best available evidence was found for the alexandrite (three RCTs, eight CTs) and diode (three RCTs, four CTs) lasers, followed by the ruby (two RCTs, six CTs) and Nd:YAG (two RCTs, four CTs) lasers, whereas limited evidence was available for IPL sources (one RCT, one CT). Based on the present best available evidence we conclude that (i) epilation with lasers and light sources induces a partial short-term hair reduction up to 6 months postoperatively, (ii) efficacy is improved when repeated treatments are given, (iii) efficacy is superior to conventional treatments (shaving, wax epilation, electrolysis), (iv) evidence exists for a partial long-term hair removal efficacy beyond 6 months postoperatively after repetitive treatments with alexandrite and diode lasers and probably after treatment with ruby and Nd:YAG lasers, whereas evidence is lacking for long-term hair removal after IPL treatment, (v) today there is no evidence for a complete and persistent hair removal efficacy, (vi) the occurrence of postoperative side-effects is reported low for all the laser systems. The evidence from controlled clinical trials favours the use of lasers and light sources for removal of unwanted hair. We recommend that patients are pre-operatively informed of the expected treatment outcome.
Article
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.
Article
There are few clinical studies directly comparing the efficacy of multiple hair removal systems in the same individual. This study evaluates the efficacy of four highly popular systems for laser hair removal. In this prospective comparison study, 10 subjects underwent treatment of unwanted hair on the back or thigh. Subjects were skin types I-III, aged 18-55 years. All were treated twice with (1) an intense pulsed light with a red filter; (2) an intense pulsed light with a yellow filter; (3) an 810 nm diode laser; and (4) a 755 nm alexandrite laser. Four treatment areas, using commonly accepted parameters for permanent hair reduction, as well as a control non-treated area were selected. Each treatment area was evaluated with a camera system specifically designed for hair counts at 1, 3, and 6 months after the second treatment by a blinded non-treating physician. Clinical results and adverse events were also noted. Evaluation of photographs at 1, 3, and 6 months revealed a significant decrease in hair counts (approximately 50%) and hair coverage (approximately 55%). In the hairs that remained after two treatments, no statistical difference was noted in hair length or diameter. There was no statistical difference in efficacy between the four different light devices. Minimal transient adverse effects were noted from all systems. The cryogen spray-based alexandrite laser showed the highest pain scores. Although hair removal with commonly used systems is, as expected, highly effective, treatment with light-based devices can cause less pain, yet show efficacy similar to laser systems.