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Abstract

In the past 5 years since their US introduction, there has been a rapid proliferation of light-based hair removal devices intended for home-use. In the last 2 years in Europe, sales already run into many tens of thousands of units with well-known multi-national companies entering the market. These guidelines provide a definition of light-based home-use technology, to inform healthcare professionals about home-use light-based technology and encourage manufacturers wishing to sell in Europe to adopt 'best practice'. The review presents the current status on standards and regulation issues and considers home-use safety issues, encompassing human, device and electrical safety, given risks to the eyes and skin from optical radiation both to the consumer and persons in the vicinity. Proposed technical measurement methodology is considered with focus on recognized critical parameters for the safe use of light-based hair removal technology including recording the technical performance and safety claims of a range of home-use hair removal devices. The literature review emphasizes potential adverse incidents and safety aspects of treating cosmetic conditions, such as unwanted hair growth. Although some regulations exist, they differ from region to region and there is a specific need for international common principles and guidelines relating to the manufacture, marketing and use of intense pulsed light and laser devices, including manufacturing standards for home-use products intended, amongst others, for cosmetic hair removal and photo-rejuvenation procedures. In these guidelines, the European Society for Laser Dermatology (ESLD) provides a professional view of what 'best practice' may imply for manufacturers and consumers alike.

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... Currently, the FDA requires compliance with certain standards and regulations for lightbased home-use devices sold in the United States. 49 These devices are based on IPL and laser technologies but operate at lower fluences than comparable in-office devices. The 810-nm diode Tria laser (Tria Beauty, Inc., Dublin, CA) and 475 to 1,200 nm IPL Silk'n device (Home Skinovations, Kfar Saba, Israel) are the current FDA-approved hair removal systems. ...
Article
Background: Unwanted hair growth is a common aesthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation. Objectives: To extensively review the literature on laser hair removal pertaining to its theoretical basis, current laser and light-based devices, and their complications. Special treatment recommendations for darker skin types were considered. Materials and methods: A comprehensive literature search related to the long-pulse alexandrite (755 nm), long-pulse diode (810 nm), long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG; 1,064 nm), and intense pulsed light (IPL) system, as well as newer home-use devices, was conducted. Results: The literature supports the use of the alexandrite, diode, Nd:YAG and IPL devices for long-term hair removal. Because of its longer wavelength, the Nd:YAG is the best laser system to use for pigmented skin. Further research is needed regarding the safety and efficacy of home-use devices. Conclusion: Current in-office laser hair removal devices effectively provide a durable solution for unwanted hair removal.
... For IPL devices, there are no such standards that have to be adhered to [ 16 ] . It is merely recommended that the data provided by the manufacturer be compared with own measurements of the handpiece and documented in an inspection book (FA ET 3 2009). ...
Article
Recent developments (new wavelengths, treatment concepts, and combinations) in the field of lasers, intense pulsed light (IPL), LED, as well as new energy and light sources have opened up new therapeutic options that extend beyond mere aesthetic indications. Thus, while fractional lasers used to be employed to merely treat wrinkles, the same devices – in the context of laser-assisted drug delivery – have now become important tools in the treatment of scars, field cancerization, and epithelial tumors. The requirements posed to physicians, both with respect to establishing the indication and conducting treatment, have been growing along with the increase in technological complexity as well as the rising number of comorbidities and comedications in a patient population that continues to age. At the same time, home-use devices have been introduced for a variety of indications. These devices are characterized by low power and special safety features aimed at preventing accidents, risks, and side effects. Despite the reduced efficacy of such self-treatment devices, there is an increased risk of misuse, given that the basic prerequisite for adequate treatment cannot be ensured, to wit, the exact diagnosis and therapeutic indication. Consequently, during hair removal or anti-wrinkle treatment, pigmented lesions and cutaneous neoplasms may be altered, thus giving rise to expected, unexpected and new side effects and complications. In the aforementioned setting, it is important that all potential users of these new technologies be properly trained in a manner that ensures those treated a maximum of safety and efficacy in accordance with the guiding principle “diagnosis certa – ullae therapiae fundamentum”.
... The efficacy of laser hair removal may be improved by developing adequate light delivery systems. Optimal timing, light sources, doses, and number of applications are also important factors for this procedure and must be well defined (Town et al., 2012;Vachiramon et al., 2012). For optimal efficacy, the light must be sufficient for an appropriate rate through the formulation and penetration of the skin, ideally to reach the target tissue with a sufficient amount of laser (Casey and Goldberg, 2008). ...
Article
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In laser dermatology applications, the process of photon absorption, the reflectance and the thermal energy diffusion in the target tissue and its surrounding tissue during laser irradiation is crucial. The aim of the study is to compare the changes of the optical power absorption per unit volume between shaving and non shaving hair on the skin surface and to demonstrate the effect of shaving of the skin surface on power absorption by Advanced System Analysis Program (ASAP) techniques. The method is performed to create hair on the skin surface and also by laser sources. Comparisons of optical power absorption have been performed between the samples of skin before and after shaving hair using the deviation and ratio of absorption power in each layer. Furthermore, the shape of Gaussian-profile in stratum corneum and epidermal layer has been compared, respectively. A power absorption of a laser increase in transmittance and decrease in diffuse reflectance occurred within a stratum corneum on the skin surface after applying shaved hair of skin. This indicates that the shaving of hair on the skin surface will have an effect on the efficacy of laser transmission as well as on the shape of the laser beam.
... This FDA recognition of the IEC standards has not yet been codified and in the interim, so as to reduce the regulatory burden on industry and the CDRH agency, FDA has released 'Laser Notice No.50' that explains which of the IEC standards will be accepted in the USA. This industry guidance allows some IEC standards for lasers to be accepted within the USA [18]. Hence, since 2007 FDA has accepted the new classification labelling. ...
Article
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Laser sources are nowadays largely adopted in medicine and hence they are widespread in medical environment, where patients are present and the users are not always highly specialized in managing laser sources. This has greatly boosted the attention towards safety issues related to exposure to laser beams and to strictly assess the values of well defined laser radiation standard parameters characterizing the level of hazard of laser sources. In this framework, we measured two of the most important parameters, Maximum Permissible Exposure (MPE) and Nominal Ocular Hazard Distance (NOHD), for some of the laser sources mostly employed in medicine.
... Even with the right intensity of laser light, however, the actual amount of energy delivered to the target presents local variations when the laser treatment spots are not evenly applied [16][17][18]. The potential threat of side effects from this nonuniformly delivered laser light is serious when we consider that these treatments are often delegated to nonphysicians or even nonmedical personnel who lack sufficient training [2,19]. ...
Article
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The uniform delivery of laser energy is particularly important for safe and effective laser hair removal (LHR) treatment. Although it is necessary to quantitatively assess the spatial distribution of the delivered laser, laser spots are difficult to trace owing to a lack of visual cues. This study proposes a novel preclinic tool to evaluate operator proficiency in LHR treatment and applies this tool to train novice operators and compare two different treatment techniques (sliding versus spot-by-spot). A simulation bed is constructed to visualize the irradiated laser spots. Six novice operators are recruited to perform four sessions of simulation while changing the treatment techniques and the presence of feedback (sliding without feedback, sliding with feedback, spot-by-spot without feedback, and spot-by-spot with feedback). Laser distribution maps (LDMs) are reconstructed through a series of images processed from the recorded video for each simulation session. Then, an experienced dermatologist classifies the collected LDMs into three different performance groups, which are quantitatively analyzed in terms of four performance indices. The performance groups are characterized by using a combination of four proposed indices. The best-performing group exhibited the lowest amount of randomness in laser delivery and accurate estimation of mean spot distances. The training was only effective in the sliding treatment technique. After the training, omission errors decreased by 6.32% and better estimation of the mean spot distance of the actual size of the laser-emitting window was achieved. Gels required operators to be trained when the spot-by-spot technique was used, and imposed difficulties in maintaining regular laser delivery when the sliding technique was used. Because the proposed system is simple and highly affordable, it is expected to benefit many operators in clinics to train and maintain skilled performance in LHR treatment, which will eventually lead to accomplishing a uniform laser delivery for safe and effective LHR treatment.
... The European Society for Laser Dermatology recently published guidelines on the safety of lightbased hair removal HUDs, in part to encourage manufacturers to adopt best practices. 2 This interim measure highlights an urgent need for regulators to catch up with market developments and pin down suitable safety standards that apply to the breadth of devices currently available and in development. Once these are in place, the need for sufficient clinical evidence of safety and efficacy will predominate before solid professional endorsement can become a reality. ...
... Various types of LHR devices based on these theories and using different light sources exist, and most such commercial devices have 510(k) clearance. 4,5 However, the skill of the LHR practitioner may affect the overall result of the procedure, including its safety and effectiveness. [6][7][8] Previously, Noh et al. 6 developed a novel tool to visualize the location of light, and thus verify the proficiency of the practitioner's performance. ...
Article
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Objective: This study aimed to evaluate the number of laser irradiation sessions, process duration, and hair removal rate required for robot-assisted automatic versus physician-directed laser hair removal. Background data: This research group previously developed and tested an automatic laser hair removal (LHR) system to provide uniform laser treatment distribution. Methods: Six subjects 20-40 years of age, with skin types III-IV completed this study. A home-use LHR device with an 810 nm diode laser was used to treat equal-sized areas of both upper thighs; a random computer generator determined the use of a robot-assisted automatic LHR system or physician-directed LHR on the right or left thigh. The treatment schedule comprised five visits; subjects were photographed and shaved, and received LHR during the first through the fourth visits at 2-week intervals. The fifth visit occurred 1 month after the fourth, and only involved photography. Results: All subjects successfully completed the clinical trial with no noticeable or permanent side effects. The average hair removal rates were 49.0% (standard error of the mean [SEM]: 4.0) and 29.5% (SEM: 4.0) for robot-assisted and physician-directed LHR, respectively. The average treatment duration and number of irradiation shots were 18 min, 30 sec (SEM: 33 sec) and 260 (SEM: 5.7) for robot-assisted LHR and 3 min, 11 sec (SEM: 15 sec) and 73 (SEM: 5.9) for physician-directed LHR. Conclusions: This clinical study successfully demonstrated the safety and effectiveness of robot-assisted LHR. The proposed novel system will benefit both patients and clinicians.
... Generation emittieren Licht im Infrarotbereich, welches häufi g zu epidermalen Kollateralschäden und einer hohen Inzidenz an Nebenwirkungen führt. Bei IPL-Geräten der 2. Generation wird meist der unerwünschte Infrarotanteil durch Wasser gefi ltert, womit das Risiko von Nebenwirkungen erheblich reduziert werden kann [ 14,15 ] Bei IPL-Geräten existieren keine solchen Standards, die eingehalten werden müssen [ 16 ] . Es fi ndet sich lediglich die Empfehlung, dass die Daten des Herstellers am ausgelieferten und betriebenen Handstück gemessen und in einem Prüfbuch niedergeschrieben werden sollten (FA ET 3 2009). ...
Article
Die Entwicklungen im Bereich dermatologischer Laser, hochenergetischer Blitzlampen, LED und neuer Energie- und Strahlquellen der letzten Jahre haben gezeigt, dass mit neuen Wellenlängen, Konzepten und Kombinationen zusätzliche, zum Teil über den ästhetischen Bereich hinaus gehende therapeutische Optionen für den Dermatologen erschlossen werden konnten. Wurden bisher zum Beispiel mit fraktionalen Lasern Falten behandelt, sind eben diese Systeme heute in Kombination mit Medikamenten wichtige Werkzeuge bei der Behandlung von Narben, bei Feldkanzerisierung und epithelialen Tumoren. Die Anforderungen an den die Indikation stellenden und vorzugsweise therapierenden Arzt steigen mit der immer komplexer werdenden Technik und den zunehmenden Komorbiditäten und Komedikationen einer älter werdenden Patientenklientel. Parallel etabliert wurden, zunächst für einige wenige Indikationen, Geräte für die Heimanwendung, die sich durch geringe Leistung und spezielle Sicherheitsvorkehrungen zur Vermeidung von Unfällen, Risiken und Nebenwirkungen auszeichnen. Trotz der reduzierten Effizienz solcher Selbstbehandlungsmaßnahmen steigt die Wahrscheinlichkeit einer Fehlanwendung, da die Grundvoraussetzung für eine korrekte Therapie, nämlich die exakte Diagnose und Indikationsstellung, nicht vorausgesetzt werden kann. Bei einer Haarentfernung können so Pigmenttumoren, bei einer Faltentherapie neoplastische Hautveränderungen adressiert und zu erwartende, unvorhergesehene und neue Nebenwirkungen und Komplikationen induziert werden. In diesem Szenario ist es wichtig, alle potenziellen Anwender dieser neuen Technologien vor deren Einsatz so zu qualifizieren, dass den Therapierten maximale Therapiesicherheit bei höchster Effizienz unter dem Leitbild diagnosis certa – ullae therapiae fundamentum garantiert wird.
... Photoepilation is a common method to remove unwanted body hair using pulses of laser or intense pulsed light (IPL), implemented both in professional systems and in home-use devices (HUDs) [1,2]. During photoepilation light is selectively absorbed by the melanin in the growing hair follicle (HF), resulting in a local temperature increase [3]. ...
Article
Objectives Photoepilation is a commonly used technology in home‐use devices (HUDs) and in professional systems to remove unwanted body hair using pulses of laser or intense pulsed light (IPL). Albeit HUDs and professional systems operate at different fluences and treatment regimes, both demonstrate high hair reduction. The underlying mechanisms, however, remain unknown partly due to high divergence of the existing literature data. The objective of this study was to develop an ex vivo photoepilation model with a set of criteria evaluating response to light pulses; and to investigate dose‐response behavior of hair follicles (HFs) subjected to a range of fluences. Methods After ex vivo treatment (single pulse, 810 nm, 1.7–26.4 J/cm², 4–64 ms pulse) human anagen HFs were isolated and maintained in culture for 7–10 days. Response to light was evaluated based on gross‐morphology and histological examination (H&E and TUNEL stainings). Results HFs treated ex vivo demonstrated a dose‐dependent response to light with five distinct classes defined by macroscopic and microscopic criteria. Fluences below 13.2 J/cm² provoked catagen‐like transition, higher fluences resulted in coagulation in HF compartments. Conclusion Observed changes in the HF organ culture model were reflected by clinical efficacy. The developed photoepilation model provides an easy and fast method to predict clinical efficacy and permanency of light‐based hair removal devices. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
... In many Western countries, legal standards for beauty equipment for medical use and for beauty salon use have been established, but standards for home-use beauty equipment vary [9] [10]. In Japan, almost all equipment is sold under the category of miscellaneous goods. ...
... Light-based home-use devices are also available and approved by the US Food and Drug Administration. These devices provide less optical energy and should be carefully used to avoid injuries to skin and eyes [200,201]. Fewer RCTs have evaluated the efficacy of these devices [202]. ...
Article
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Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected. Symptoms of PCOS arise during the early pubertal years. Both normal female pubertal development and PCOS are characterized by irregular menstrual cycles, anovulation, and acne. Owing to the complicated interwoven pathophysiology, discerning the inciting causes is challenging. Most available clinical data communicate findings and outcomes in adult women. Whereas the Rotterdam criteria are accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated. Diagnostic features for adolescent girls are menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia. Pelvic ultrasound findings are not needed for the diagnosis of PCOS in adolescent girls. Even before definitive diagnosis of PCOS, adolescents with clinical signs of androgen excess and oligomenorrhea/amenorrhea, features of PCOS, can be regarded as being "at risk for PCOS." Management of both those at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle interventions, and therapeutic interventions targeting their symptoms. Interventions can include metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne. In addition to ascertaining for associated comorbidities, management should also include regular follow-up visits and planned transition to adult care providers. Comprehensive knowledge regarding the pathogenesis of PCOS will enable earlier identification of girls with high propensity to develop PCOS. Timely implementation of individualized therapeutic interventions will improve overall management of PCOS during adolescence, prevent associated comorbidities, and improve quality of life.
Article
Background: Home optical devices are becoming an increasingly popular treatment modality sought out by patients for dermatologic pathologies such as acne, hair removal and anti-aging, as these devices are a low-cost and convenient therapy choice. Methods: An Internet search using PubMed.gov was completed with search terms, "home device dermatology," "home device acne," "home device hair" or "hair removal," and "home device aging." Results: Currently, there are multiple home optical devices available on the market. These devices have been approved for the treatment of acne, scars, hair removal, and wrinkles using intense pulsed light, light-emitting diode, heat, infrared, low-level light therapy, and laser. Although studies on home devices are limited, current dermatologic literature shows that these devices are promising with significant post-treatment results as well as a high level of safety. Conclusions: Home optical devices are mostly used without medical practitioner supervision. As home devices usually deliver less energy per session than with professional treatments, it is important that consumers are given realistic expectations of post-treatment outcomes. Patients may use home devices without disclosure to their physician and it is important as healthcare professionals to be aware of the existence of these devices, how to use the devices properly (including what diseases can be treated and which skin types are considered safe for use), as well as any adverse effects that may occur. New research endeavors are being completed to explore the used of home devices for the treatment of chronic inflammatory diseases such as psoriasis.
Chapter
This chapter will describe the laser security aspects from the classification of laser’s risk until the preventive measures. The main risks such as eye risks, skin risks, teeth risks, plume risks, fire risks, and electrical risks will be discussed, and preventive measures since protective equipment until behavioral aspects will also be addressed.
Article
Background Despite the widespread use of intense pulsed light (IPL) technology in cosmetic dermatology, the effects of its repeated use on facial skin sensitivity in healthy individuals remains unknown. Methods Seventeen healthy female volunteers were included in the study. We measured objective biophysical parameters of the skin, including transepidermal water loss (TEWL), skin glossiness, thickness and density of the epidermis and dermis, sensory nerve current perception threshold (CPT), and regional blood flow before and after treatment at different time points. Results Sixteen volunteers completed a follow up of 12 months. The treated side of the face showed a decreased TEWL on D1 and D3, which reverted to normal on D7. Epidermal thickness increased and skin glossiness decreased on the treated side on D1, but returned to normal on D3. We found no statistically significant differences in CPT values or in regional blood flow volume and velocity, with the exception of D1, which exhibited a higher regional blood flow volume on the treated side. Conclusion Repeated IPL treatments had no effects on facial skin barrier function, skin nerve sensitivity, or local microcirculation among healthy individuals. IPL is a safe skin care procedure that does not affect skin sensitivity.
Chapter
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
The prevailing advice is to avoid sun exposure after intense pulsed light (IPL) hair removal. However, no systematic evaluation of ultraviolet radiation (UVR) after IPL hair removal exits. Therefore, we investigated the occurrence of side effects in subjects receiving solar-simulated UVR after a low-fluence IPL treatment with a home-use device. Sixteen subjects with Fitzpatrick skin types (FST) II-V were enrolled. Three constitutive buttock blocks (4.4 × 6.4 cm) were each subdivided into four sites, randomized to one IPL exposure of 0, 7, 8, or 10 J/cm(2) (spectral output 530-1100 nm). Blocks were randomized to no UVR or three standard erythema doses (SEDs) UVR either 30 min or 24 h after IPL. Follow-up visits were 48 h, 1 week, and 4 weeks after IPL. Outcome measures were (i) clinical skin reactions, (ii) reflectance measurements of erythema and pigmentation, and (iii) pain. Subjects with FST II-IV experienced no skin reactions up to 4 weeks after IPL, neither erythema, edema, blisters, crusting, textual, nor pigment changes. Reflectance confirmed no change in erythema and pigmentation (p ≥ 0.090). UVR exposure induced erythema and increased pigmentation. The combination of IPL and UVR induced skin reactions not different to responses from UVR (IPL-UVR vs. UVR, p ≥ 0.164). Pain was generally low (median 1, range 0-4) and correlated positively with fluence and pigmentation (Spearman's rho ≥ 0.394, p < 0.001). One subject with FST V experienced perifollicular hyperpigmentation after IPL and slightly more intense when exposed to UVR. A single UVR exposure of three SEDs either shortly or 1 day after low-fluence IPL causes no amplification of skin responses in constitutive skin of individuals with FST II-IV.
Chapter
Laser hair removal is one of the most common non-surgical procedures performed in the United States. Excessive, unwanted hair can be seen in all ages, ethnicities and skin types and lasers can help provide a permanent reduction in hair growth. Professional and home-based laser and light systems are both currently available, with professional systems including the 694 nm ruby laser, 755 nm Alexandrite laser, the 800 nm diode laser, the long-pulsed 1,064 nm Neodymium doped: yttrium aluminum garnet (Nd:YAG) laser, intense pulsed light (IPL), and radiofrequency. While generally safe, side effects from laser hair removal are possible and should only be used by trained medical professionals after performing a thorough history and physical examination. This chapter will provide a succinct approach to laser hair removal, including but not limited to available modalities, patient selection, reported side effects and management of care.
Article
Objectives This review has the following objectives: Firstly, it provides an explanation of the evolution of laser/intense pulsed light (IPL) hair reduction modalities from high fluence professional devices to low fluence home‐use appliances. Secondly, it summarises published literature reviews on home‐use devices (HUDs) as evidence of their growing credibility. Thirdly, it proposes mechanistic differences in light delivery regimes and the resulting divergences in mode of action. Materials and Methods An extensive literature search was performed to review the progress of laser/IPL‐induced hair reduction and determine what evidence is available to explain the mode of action of professional and HUDs for hair removal. Establishing the likely biological mode of action of professional high‐fluence systems versus home‐use low‐fluence appliances was performed by combining data obtained using ex vivo hair follicle (HF) organ culture and the clinical results involving human participants. Results Significant basic science and clinical evidence has been published to confirm the clinical efficacy and technical safety of many laser and IPL home‐use devices for hair removal. Clearly, HUDs are different compared to professional systems both in terms of fluence per pulse and in terms of biological mechanisms underlying hair removal. Here we presented data showing that a single low fluence pulse of both 810 nm laser (6.6 J/cm², 16 ms) and IPL (9 J/cm², 15 ms and 6.8 J/cm², 1.9 ms) leads to induction of catagen transition. Catagen transition was characterized by morphological changes similar to what occurs in vivo with occasional detection of apoptosis in the dermal papilla and outer root sheath cells. This suggests that high hair reduction can be expected in vivo and longer‐term treatment might result in HF miniaturization due to a cumulative effect on the dermal papilla and outer root sheath cells. In line with this hypothesis, in this review we demonstrate that long‐term application of a commercially‐available home‐use IPL appliance resulted in persistent hair reduction (80%) one year after last treatment. These data are in line with what was previously reported in the literature, where clinical studies with home‐use IPL appliances demonstrated high efficacy of hair reduction on female legs, armpits and bikini zones, with full hair regrowth after four treatments following cessation of IPL administration. Limitations of HUDs include lack of hair clearance for very dark skin types and low speed of treatment compared with professional devices. Numerous uncontrolled and controlled clinical efficacy studies and technical safety investigations on consumer‐use appliances support many of the leading manufacturers' claims. Analysis & Conclusions Manufacturers make consumer appliances safe and easy to use by considering “human factors,” needs and capabilities of a variety of users. Safety is of primary concern to manufacturers, regulators and standards bodies as these appliances may be accessible to children or their use attempted on unsuitable skin types without full awareness of potential side effects. Consumer cosmetic appliances are provided with warnings and obvious safety notices describing the nature of any ocular or dermal hazard and precautions for reducing risk of accidental injury, infection, etc. HUDs employing optical energy are provided with design and engineering controls such as safety switches, alarms and sensors to prevent their incorrect operation or eye exposure. In‐vivo studies demonstrated that low fluence home‐use hair removal devices can result in high hair reduction efficacy after a short treatment regime, while prolonged and less frequent (once in six weeks) maintenance treatment over a year can lead to high and sustained hair reduction even one year after cessation of treatment. Home‐use hair removal devices can be a useful adjunct to professional in‐office treatments with high professional awareness. There are sufficient positive arguments for practitioners to make the case to patients for HUDs as “companion” products to professional treatments. In addition, devices for hair removal can be used effectively as stand‐alone products by the consumer if they are willing to adopt a regime of regular or frequent use. Further clinical studies involving dynamic observation of HF cycle stage and type (terminal vs. vellus) over the total duration of treatment, for example, using biopsies or non‐invasive imaging are necessary to confirm the proposed mode of action of low fluence pulses in a combination with treatment and maintenance regimes. Lasers Surg. Med. 9999:1–10, 2018. © 2019 Wiley Periodicals, Inc.
Article
Demand for long-term hair reduction treatments has increased dramatically around the world in recent years, due to traditional factors, fashion, sport, wellbeing and health requirements. Some of the most popular options include laser and intense pulsed light (IPL) treatments, which are often administered by aesthetic practitioners. This article will discuss the hair growth cycle, as well as treatment options, parameters and outcomes.
Article
The risk of adverse skin effects following light-based hair removal is greater in pigmented skin based on the theory of selective photothermolysis. Thus sunlight-induced pigment i.e., facultative pigmentation, increases the risk of adverse skin effects, perhaps disproportionately. The aim of this study was to evaluate the influence of constitutive and facultative skin pigmentation on low-fluence intense pulsed light (IPL)-induced adverse skin effects. Twenty-one subjects with Fitzpatrick skin type II-IV were enrolled. Two buttock blocks were randomized to receive 0 or 8 solar simulated ultraviolet radiation (UVR) exposures of consecutively increasing Standard Erythema Doses (2-4 SED). Each block was subdivided into four sites, randomized to receive IPL of 0, 7, 8, or 10 J/cm(2) , once a week for 3 weeks. Biopsies were taken 16-24 hours after the first IPL exposure and subjects were seen 1 and 4 weeks after the last IPL exposure. Outcome measures were: (i) skin reactions, (ii) pain, (iii) mRNA expression of pigment-markers microphthalmia-associated transcription factor (MITF) and pro-opiomelanocortin (POMC), and (iv) clinical appearance of biopsy wounds. Skin pigmentation increased after UVR (baseline median 13.8%, after UVR 28.1%, P = 0.0001) in all skin types. Subjects reported low pain intensities (median 1.5, scale 0-10) and experienced transient erythema immediately after IPL exposure. No persistent erythema, blisters, crusting, textual, or pigment changes were observed. The risk of erythema and pain intensities increased with IPL dose and skin pigmentation (P < 0.03). There was no difference in pain or skin reactions in skin with similar degree of natural and facultative pigmentation (P ≥ 0.104). Expression of cellular pigment-markers was not influenced by IPL exposure, neither in constitutive nor in facultative pigmented skin. Clinical appearance of biopsy wounds was unaffected by IPL exposure. The prevalence and intensity of low-fluence IPL-induced adverse skin effects depended on IPL dose and skin pigmentation regardless of the origin, i.e., constitutive versus UV induced. Lasers Surg. Med. © 2013 Wiley Periodicals, Inc.
Article
Background: The use of light-based home-use hair removal devices has seen a significant increase in the last decade all over the world. Home-based devices would be especially more relevant in the context of the COVID-19 pandemic, with patients having less access to laser hair removal in clinics. This survey attempted to evaluate the practices-related use of light-based home-use hair removal devices in our region and also to assess patient satisfaction related to the same. Materials and methods: This was a cross-sectional survey using an electronic questionnaire. Results: Out of a total of 111 valid responses, 39 had used light-based home-use hair removal devices. The most common type used was intense pulse light-based devices. On a scale of 1-10, the average satisfaction with the product for hair removal was 6.07. Incidence of side effects was very low (only 4 out of 39 mentioned side effects), and the most common side effects mentioned were redness, "bumps," burns, and discoloration on the lased sites. Conclusions: The frequency of use of light-based home hair removal devices is quite high in our region. Patients seem to be satisfied with the same, and the incidence of side effects is low in our population.
Article
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The current annual global market for domestic intense pulse light (IPL) hair removal has been estimated at US $1 billion and continues to grow. The five key technological parameters to consider in cutaneous photo-therapy are wavelength, energy density, pulse duration, spot size and spatial distribution. Uneven energy distribution in the treatment area can result in over or under treatment of the treated area, thus causing dissatisfaction or harmful results. This study investigates a method of measuring and analysing spatial distribution of a number of commercially available home-use IPL systems as there is no quantitative method to conduct and compare spatial distribution at the present. Using a CCD camera and a phosphorescent screen to extend the pulse duration, averaged time frames were analysed using Matlab mathematic software. 3D graphical images of the data are presented to show the spatial profile of five commercially available IPL systems. Numerical analysis of the data was completed by two methods, arithmetical mean roughness and path difference.
Article
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The domestic market for home-use hair removal devices is rapidly expanding and there are numerous intense pulsed light (IPL) products now available globally to consumers. Technological challenges for the design of such devices include the need to be cost-effective in mass production, easy to use without training, and most importantly, clinically effective while being eye-safe. However inexpensively these light-based systems are produced, they are designed to cause biological damage to follicular structures, so precautions to prevent both ocular and epidermal damage must be considered. At present, there are no dedicated international standards for IPL devices. This review directly compares three leading domestic IPL hair removal devices: iPulse Personal (CyDen, UK), Silk'n/SensEpil (Home Skinovations, Israel), and SatinLux/Lumea (Philips, Netherlands) for fluence, emitted wavelength spectrum, time-resolved footprint, and spatial distribution of energy. Although each device has a primary mechanical or electrical safety feature to ensure occlusion of the output aperture on the skin to prevent accidental eye exposure, the ocular hazard of each device has been measured to IEC TR 60825-9 standard using an Ocean Optics HR2000+ photo spectrometer for both potential corneal and retinal damage. Using established measurement methods, this review has shown that the measured output parameters were significantly different for the three systems. Using equipment traceable to national standards, one device was judged at its two highest settings to be hazardous for naked eye viewing. This investigation also reports on the significantly different pulse durations of the devices measured and considers the potential impact on safety and efficacy in the light of the theory of selective photothermolysis. Although these devices offer low-cost personal convenience of treatment in the privacy of the home, ocular safety may be inadequate in the event of primary safety mechanism failure.
Article
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Intense pulsed light (IPL) systems have evolved and crossed over from the clinic to the home. Studies have shown home-use IPLs to be clinically effective but there has been no published data on ocular safety. It was our aim to measure the spectral and temporal optical radiation output from a home-use IPL and assess the ocular hazard. The iPulse Personal is a new home-use IPL hair reduction system. We measured its optical radiation spectral output using a calibrated diode array spectrometer that was traceable to national standards. Pulse duration was determined by measurement with a fast photodiode. The results from these measurements were used to assess the optical radiation hazard to the human eye. Retinal thermal hazard (RTH), blue light hazard (BLH), and infrared radiation hazard to the cornea and lens were assessed in accordance with IEC TR 60825-9 and the International Committee on Non-Ionizing Radiation Protection (ICNIRP) Guidelines on Limits of Exposure to Broad-band Incoherent Optical Radiation, as there are no specific international IPL standards. Neither the BLH radiance dose nor the infrared radiation hazard to the cornea and lens irradiance exceeded the exposure limit values (ELVs) set by the ICNIRP. The RTH radiance, however, was exceeded at a fluence of 11 J cm(-2) and pulse duration of 16 milliseconds. Following these results the settings on the IPL were adjusted and the RTH was no longer exceeded at a new fluence of 10 J cm(-2) and pulse duration of 26 milliseconds. The home-use device that we assessed does not present an optical hazard according to currently available international standards.
Article
Hirsutism, a troublesome cosmetic problem, may also be a sign of serious systemic disease that can be screened for by means of the patient's history, physical examination, and certain basic blood tests. Most patients with functional hirsutism have elevated production rates of testosterone, elevated metabolic clearance rates of testosterone, depressed levels of sex hormone-binding globulin, and elevated levels of serum-free testosterone and hair follicle sensitivity. Once a neoplastic source is ruled out and hirsutism established as functional, essentially empiric treatment, including low-dose dexamethasone, oral contraceptives, and spironolactone, has proved to be effective.
Conference Paper
Despite the widespread use of lasers for hair removal there is little data published on the incidence of side effects from this treatment. We aimed to generate data on a large number of patients receiving laser hair removal to obtain an accurate assessment of the incidence and type of side effects resulting from treatment. A multicentre prospective study of patients attending for laser hair removal was conducted to determine incidence of side effects in relation to skin type and laser(s) used. Laser hair removal is associated with a low incidence of side effects which are self-limiting in the majority of cases. Highest incidence of side effects was seen in darker skinned patients treated with the long pulsed ruby laser. Laser hair removal is inherently safe. For darker Fitzpatrick skin types the long pulsed Nd:YAG laser is preferred to the ruby laser.
Article
Despite the widespread use of lasers for hair removal there are few data published on the incidence of side effects from this treatment.Objective The aim of this study was to generate data on a large number of patients receiving laser hair removal to obtain an accurate assessment of the incidence and type of side effects resulting from treatment.MethodsA multicenter prospective study of patients presenting for laser hair removal was conducted to determine incidence of side effects in relation to skin type and laser or lasers used.ResultsLaser hair removal is associated with a low incidence of side effects that are self-limiting in the majority of cases. The highest incidence of side effects was seen in patients with darker skin treated with the long-pulsed ruby laser.Conclusions Laser hair removal is inherently safe. For darker Fitzpatrick skin types the long-pulsed neodymium:yttrium-aluminum-garnet laser is preferred to the ruby laser.
Article
Despite the widespread use of lasers for hair removal there are few data published on the incidence of side effects from this treatment. The aim of this study was to generate data on a large number of patients receiving laser hair removal to obtain an accurate assessment of the incidence and type of side effects resulting from treatment. A multicenter prospective study of patients presenting for laser hair removal was conducted to determine incidence of side effects in relation to skin type and laser or lasers used. Laser hair removal is associated with a low incidence of side effects that are self-limiting in the majority of cases. The highest incidence of side effects was seen in patients with darker skin treated with the long-pulsed ruby laser. Laser hair removal is inherently safe. For darker Fitzpatrick skin types the long-pulsed neodymium:yttrium-aluminum-garnet laser is preferred to the ruby laser.
Article
Background. Postinflammatory hyperpigmentation (PIHP) is a frequently encountered problem in many cosmetic procedures. The treatment of PIHP is difficult and remains a challenge. Objective. To treat a patient who developed multiple hyperpigmented macules on her thighs due to sun exposure after treatment of unwanted hair using a normal-mode ruby pulse laser. Methods. The patient was treated daily with tretinoin (Retin A) 0.1% cream, triamcinolone 0.1% cream, and hydroquinone 4% cream with sunscreen (Solaquin forte), and was to avoid sun exposure. Several sites received monthly treatment of 40% trichloroacetic acid (TCA). The degree of clinical improvement of the hyperpigmentation was assessed by both the physician and the patient. Results. Cosmetic results were fair. The amount of hair in her thighs was reduced but the PIHP responded only slightly to therapy. Conclusion. To our knowledge this is the first case of solar-induced PIHP following laser hair removal. The treatment of PIHP is difficult because there are few therapeutic options that are consistently successful. Avoidance of exposure to ultraviolet light should be emphasized to all patients prior to laser therapy. We demonstrated that serial TCA peels provided an additional benefit compared to medical treatment.
Article
To promote awareness and prevention of ocular damage that can occur during Intense Pulsed Light (IPL) treatments of the periocular areas. A retrospective chart review was conducted of 2 cases involving ocular damage following IPL procedures that were treated at Bascom Palmer Eye Institute for ocular complications. Routine data were collected during ophthalmic examinations. Case 1: A 36-year-old female presented with eye pain, marked pupillary constriction, and anterior uveitis an hour after receiving IPL treatment to the face. Within 1 month, the damage had progressed to posterior synechiae and iris transillumination defects. She continues to have pain and severe photophobia due to permanent iris atrophy and transillumination that have persisted for years. Case 2: A 27-year-old female presented with severe eye pain, vision disturbances, pupillary defects, and anterior uveitis 3 days after IPL of an eyelid freckle. At 2 months follow up, the iris and pupillary defects remain permanent. The patient continues to suffer from photophobia and pain. The pigmented iris absorbs light in the same wavelength range of IPL, thus remaining vulnerable to IPL exposure, especially when applied to the periocular area. The fact that IPL is not a laser may give people a false sense of security regarding damage to the eye. The cases presented give evidence that periorbital IPL treatment may permanently affect pigmented intraocular structures. It is imperative for treating physicians to be aware of these hazards and to use appropriate eye protection to prevent ocular damage.
Article
To describe a case of ocular complications associated with laser-assisted periorbital cosmetic treatment and to recommend consideration of the ocular damage caused by dermatological laser therapy, including pupillary distortion and anterior uveitis. Case report. A 29-year-old Caucasian woman underwent cosmetic alexandrite laser therapy in the left upper eyelid area without protective eye shields. She complained of an irregular oval pupil, photophobia, and blurred vision in her left eye. Initially, her best-corrected visual acuity (BCVA) was 30/25 (OD) and 30/25 (OS). Slit-lamp biomicroscopy revealed a distorted left pupil with 3+ cell activity in the anterior chamber, but normal intraocular pressure. She was treated with topical corticosteroids. However, marked anterior chamber activity, pigment dispersion over the iris surface, and deteriorating BCVA of 10/25 (OS) had developed at the two-week follow-up. The ocular inflammation subsided gradually and her BCVA returned to normal after intensive steroid treatment. At the six-month follow-up, an ocular examination showed poor pupillary motility and persistent pigment over the iris surface. The patient still suffered from glare in dim light and experienced problems with dark adaptation. Alexandrite laser treatment of the upper eyelid region may penetrate the eyelid, causing anterior uveitis and irreversible damage to the iris. We recommended appropriate eye protection during this therapeutic procedure.
Article
The authors have indicated no significant interest with commercial supporters.
Article
The principle of selective photo-thermolysis has been studied extensively for hair removal applications in a medical setting. A new, portable, hand-held device featuring two filtered Xenon lamps that utilizes pulsed light in low optical fluencies for hair removal has been developed for consumer use. The purpose of this clinical study was to determine the efficacy and safety of this low-energy, pulsed-intense light device intended for home use hair removal. STUDY DESIGN/ MATERIALS AND METHODS: The treatment group consisted of 10 adults with skin types I-IV who possessed unwanted dark hair in the non-facial region. The subjects received between 4 and 6 treatments on a bi-weekly basis with the device by a trained member of the clinical staff. The clinical responses were evaluated by performing manual hair counts using magnified vision and photographs which were obtained prior to treatment and at each subsequent visit. Mean hair reduction was 36% 4 weeks after the final treatment and 10% 12 weeks after the final treatment. This resulted in a mean hair count reduction of 23% over the two follow-up appointments. There was no definitive correlation between customer satisfaction and hair count reduction. Adverse reactions were limited to transient, localized, post-treatment erythema. No complications were encountered. This low-energy, pulsed-light device is a quick, safe, and relatively effective at-home hair reduction treatment option in patients with various skin phototypes.
Article
Hirsutism is a common clinical condition seen in female patients of all ages. It affects around 5-10% of the women and is a common presenting complaint in the dermatological out patient department for cosmetic reasons. The cause is mainly hyperandrogeneism, which may be ovarian or adrenal. It may be part of a rare metabolic syndrome, drug induced, or just idiopathic. Hirsutism has a huge psychosocial impact, especially in the young females. This article reviews the current evaluation guidelines and management of hirsutism.
Article
Today, more than 10% of the Western population has at least 1 tattoo, with prevalence of up to one-fourth in the cohort younger than 30 years of age. Many of these individuals come to regret their decision within months due to several reasons, often socially-related, and seek medical treatment. The discovery of selective photothermolysis has enabled the targeted destruction of tattoo pigments with only minimal damage to the surrounding tissue and limited risk of adverse effects, which contrasts previously used nonspecific methods. This treatment modality requires laser pulses of short durations (nanoseconds) and high intensities. However, the inappropriate use of laser parameters, such as inadequate pulse duration, can unnecessarily increase the incidence of permanent adverse effects. This article provides an overview of applicable laser systems and therapeutic strategies for optimized tattoo removal.
Article
Laser hair removal is a safe and effective procedure for the treatment of unwanted body hair but is not exempt from side effects. A rare but significant adverse effect with this treatment modality is paradoxical hypertrichosis. To evaluate the potential etiologies, risk factors, related laser types, and treatment options for the development of excess hair after laser therapy. An analysis of previously published case studies and review articles along with our own experience was used to gather information regarding this phenomenon. Paradoxical hypertrichosis has a low incidence, ranging from 0.6% to 10%, and most commonly occurs on the face and neck. All laser and light sources have the potential to cause hair induction, especially in individuals with darker skin types (III-VI); with dark, thick hair; and with underlying hormonal conditions. Possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Treatment for paradoxical hypertrichosis is laser therapy of the affected area. Paradoxical hypertrichosis is a rare side effect of laser hair removal; the pathogenesis of this event remains widely unknown. We recommend further large-scale studies to investigate this effect. The authors have indicated no significant interest with commercial supporters.
Article
A small, light-weight, low-energy, and low-cost IPL system designed for home use (Silk'n; HomeSkinovations, Kfar, Saba, Israel) was tested for efficacy and safety on 34 test individuals and 92 sites. Each of the patients underwent informed consent and performed self-treatment at the clinic supervised by an experienced laser hair removal nurse. The pre- and post-treatment hair counts were performed and the reduction counts were analyzed by a blinded observer.
Article
To evaluate the reduction in unwanted body and facial hair at various body sites of Fitzpatrick skin types I-III and the efficacy, comfort and safety of this treatment intended for home-use by the general public. In this non-randomized study, 29 individuals were given three sequential weekly treatments on a total of 31 body and facial areas including the axilla, bikini area, abdomen, neck, chin and upper lip using a novel intense pulsed light device. All participants completed a simple self-assessment questionnaire, as well as an evaluation of pain/discomfort. The mean reduction in terminal hair counts was 47% at 4 weeks' follow-up and 41% at 6 months' follow-up after completing three sequential weekly treatments. Overall, 84% of participants showed a significant percentage of hair reduction (p<0.01) at the 6-month follow-up, with a mean of 51% (range 25-86%). No treatment-related side effects were reported, with little or no discomfort reported during the treatment. Only mild erythema was noted immediately post-treatment. In total, 85% of the participants were either pleased or very pleased with the results 1 month after the third treatment. In simulated consumer use, this home-use IPL demonstrated a significant, quantifiable and sustainable reduction in unwanted body and facial hair with minimal side effects.
Article
Removal of unwanted hair is the most popular skin treatment worldwide. Over the past decade, various lasers and light sources for epilation have been advocated for use in an office setting, although most people continue to treat unwanted hair with a variety of temporary physical methods (e.g., waxing, shaving) in a home setting, presumably due to cost and convenience factors. To evaluate the safety and efficacy of a low-energy pulsed-light device intended for home-use hair removal. Twenty women (skin phototypes I-IV) with dark terminal hair in nonfacial sites (axilla, forearms, inguinal region, legs) self-administered three treatments at 2-week intervals using a handheld intense-pulsed-light device. Matched untreated skin sites were also studied. Hair counts and clinical photographs were obtained pretreatment and at 1, 3, and 6 months after the third treatment. Side effects and patient satisfaction scores were recorded. All patients showed a positive clinical response to treatment, with reduction of unwanted hair. No reduction of hair was noted in untreated matched areas. Hair counts were reduced 37.8% to 53.6% 6 months after the three treatments. Skin region influenced clinical response, with lower legs exhibiting greater hair reduction than arms and inguinal and axillary areas. Mild erythema was experienced in 25% of patients, but no other side effects or complications were encountered. Patient satisfaction scores were high, with all patients stating that they would purchase the device for future home use. CONCLUSIONS Low-energy pulsed light can be applied safely and effectively for at-home hair removal in a variety of nonfacial locations and skin phototypes I-IV.
Article
In the Western world, more than 10% of the population have at least 1 tattoo. If the tattoo is removed, the tattoo pigment particles in the skin can be selectively destroyed by means of selective photothermolysis. This treatment requires laser pulses of short durations (nanoseconds) and high intensities. We report on 12 patients who received treatments with improper treatment parameters. In all patients, we diagnosed hypo- or hyperpigmentations and scar formation at the treatment site. In particular, the pulse duration of the light sources or lasers applied were considerably longer than those required by the principles of selective photothermolysis. The light intensities of those devices are normally not sufficient to destroy the pigment particles. Instead of destruction, the pigment particles in the skin are heated up and the heat is conducted to the adjacent tissue causing unspecific tissue injury. Lasers or intense pulsed light sources with millisecond pulses and low light intensities are clearly not suitable to be applied for tattoo removal.
Article
Clinical observations have suggested that wound healing may be altered in patients treated with systemic isotretinoin. In this study, we examined the effects of systemic isotretinoin on dermal wound healing and connective tissue metabolism in a rabbit ear model. Forty 6-mm punch-biopsy wounds were created in the ears of two control rabbits as well as two experimental animals fed isotretinoin, 4 mg/kg per day. Clinical inspection and histologic examination revealed no difference between the control and isotretinoin-treated rabbits in terms of the time required for complete wound healing or the appearance of the final scar. The tissue removed from the wound site at days 0, 7, 14, and 21 after wounding was subjected to analysis of a collagen production and collagen gene expression. Collagen production, determined by the synthesis of [3H]hydroxyproline after incubation of tissue slices with [3H]proline in vitro or by the measurement of the steady-state levels of types I and III procollagen mRNAs, was not significantly different between the two groups. The results indicate that systemic administration of isotretinoin does not affect collagen synthesis in the rabbit ear model of wound healing.
Article
We report the observation of delayed wound healing and keloid formation in three patients, following dermabrasion or Argon laser treatment administered while they were receiving isotretinoin for acne or rosacea.
Article
Suitably brief pulses of selectively absorbed optical radiation can cause selective damage to pigmented structures, cells, and organelles in vivo. Precise aiming is unnecessary in this unique form of radiation injury because inherent optical and thermal properties provide target selectivity. A simple, predictive model is presented. Selective damage to cutaneous microvessels and to melanosomes within melanocytes is shown after 577-nanometer (3 x 10(-7) second) and 351-nanometer (2 x 10(-8) second) pulses, respectively. Hemodynamic, histological, and ultrastructural responses are discussed.
Article
The use of isotretinoin for the treatment of acne has increased over the past 10 years because of its effectiveness and the limited and generally reversible adverse effects associated with it. Although not mentioned in comprehensive reviews of the adverse effects of isotretinoin therapy, hypertrophic scar and keloid formation, both spontaneous and associated with cutaneous injury, are potential risks.¹ Dermatologists and cosmetic surgeons have noted an increased incidence of keloid and hypertrophic scar formation with dermabrasion, excisions, and argon laser treatment.2,3 These therapies all share local disruption in the structure of collagen in the skin. The pulsed dye laser (585 nm, 450 microseconds) has been proven safe and effective treatment for various small-diameter vascular processes, such as capillary vascular malformations, hemangiomas, telangiectases, pyogenic granulomas, and angiomas. Using the principles of selective photothermolysis, the pulsed dye laser can deliver high-intensity energy to a target vessel with little to
Article
The majority of lasers used for hair removal target melanin as the chromophore. In contrast with other cutaneous applications of lasers, lasers used for hair removal must generate a limited, controlled degree of thermal damage to permanently remove hairs. To remove excess back hair from two male patients, one with a history of multiple nevi, and prior biopsies showing features of dysplastic nevi, and the other with large nevi greater than 6 mm in diameter and a family history of malignant melanoma. Both patients received monthly treatments with an 810 nm, pulsed, high-power diode laser using a fluence of 20 J/cm2 and 25-30 J/cm2, respectively, and a pulse duration of 30 ms. Both patients presented 1 month after their last treatment with changing nevi within the treatment areas. Neither patient had clinical inflammation or other alterations suggestive of change in the nevi related to treatment. Thus, the nevi were excised with no mention of the previous laser treatment. The histologic features in all nevi were similar. There was subepidermal blister formation with elongation and disruption of nevus cells. There was homogenization of the collagen within the papillary dermis in all lesions. Only small foci of nevus cells could be identified in the dermis in some of the biopsy specimens. In these biopsy specimens, the dermal stromal matrix homogenization extended into the reticular dermis. Laser targeting of nevus cells and surrounding structures may produce clinically atypical nevi in areas previously treated for hair removal. This should be kept in mind, especially in patients with a history of dysplastic nevi or with a personal or family history of malignant melanoma.
Article
The use of lasers and intense pulsed light (IPL) technology has become established practice in dermatology and aesthetic medicine. The increase in popularity and widespread use of such equipment has been accompanied by a sharp increase in the number of case reports about professional errors. We present 14 case studies of professional errors. Selected representative case reports are used to illustrate and discuss typical professional errors and serve as the basis for creating preventive strategies. Recommendations have been developed for the following areas: physician training, patient information, documentation, diagnosis, indication, test treatment, and performing treatment. The use of lasers and IPL technology in dermatology and aesthetic medicine requires practitioners not only to have high levels of training and experience, but also to exercise professional judgment. In spite of all of the precautions taken, the risk of complications and side effects can be reduced but not completely eliminated.
Article
Laser skin surgery is not without risk and some degree of downtime in most situations. Patient satisfaction is key to the perceived success of the procedure. Therefore, the physician must fully explain all risks, potential complications, and expected morbidity associated with any laser treatment to be performed. Although many side effects can be avoided by use of appropriate intraoperative technique and adequate postoperative management, untoward effects may still occur and must be promptly identified and addressed. An informed patient is an important factor in the healing process and contributes to the success of the procedure.
Article
Lasers and light sources are now used worldwide for permanent or prolonged hair removal. Patients now prefer lasers and light sources for hair removal because of their noninvasiveness and fewer reported side effects. To study and report on leukotrichia that developed following application of intense pulsed light (IPL). From February 9, 2001 to February 14, 2002 a total of 821 patients were treated for unwanted hair. The system used was a noncoherent IPL system, with a 650 nm flashlamp filter; the parameters used varied with different Fitzpatrick skin types. The patients were treated monthly, with the rate of hair loss, measured by hair counts, and possible side effects recorded. Twenty-nine of 821 patients treated developed leukotrichia. Thirteen patients had no white or gray hairs before IPL therapy; the remaining 16 patients, who had few white hairs before treatment reported accelerated development of new white hairs starting after the first or second IPL therapy. Restoration of hair color occurred in 9 patients and the remaining 20 patients had no improvement or worsening of the condition within the next 2-6 months. Temporary or permanent leukotrichia may develop following IPL and laser hair removal therapy. This finding may be explained by the difference in the thermal relaxation times of melanocytes and germinative cells. The light absorbed and the heat produced by melanin may be sufficient enough to destroy or impair the function of melanocytes but insufficient to damage the hair follicle cells.
Article
Laser and other light sources have been used to treat vascular and pigmented skin lesions and to remove tattoos and unwanted hair, with varying degrees of success and various side effects. It has not yet been reported that hair growth can occur as a side effect of such treatments. In this paper two cases are presented, one port wine stain and one tattoo, that were each treated several times with an intense pulsed light source (IPLS) for removal. Terminal hair, not present before treatment, partially developed in treated areas of both lesions. Local inflammatory reactions are believed to trigger such outcomes.
Article
A case of focal damage to the iris with distortion of the pupil secondary to PhotoDerm therapy in a 2-year-old boy is reported. To study ocular complication of photoDerm VL therapy for facial port-wine stain. METHODS. : Observatory case report. PhotoDerm VL therapy may damage ocular tissues. Appropriate protection during the procedure is essential.
Article
This study was designed to evaluate the safety and effectiveness of a small, low energy light based system for hair removal, when used by non-healthcare professionals ("patients") for self treatment in home-like environment following instructions and guidance provided by a physician. A total of 73 patients between the ages of 19 and 54 years with skin types I through IV were enrolled in the study out of which 67 completed the study. Two treatment sites were chosen from among the arms, axilla, legs, bikini, back, belly, chest or face. The hair on the sites was trimmed and photographed. Each patient performed two self-treatments, using the hair removal device on their designated body sites, under the Investigator's direction. The first self-treatment was performed at the Investigator's office by the patient while the second self-treatment was performed 4 weeks later at a hotel room, simulating the home environment. Follow-up visits to evaluate the safety and efficacy of the treatments were performed 2 and 12 weeks following the last self-treatment. The mean hair reduction was 33.6%, 4 weeks after the first self-treatment, 44.3%, 2 weeks following the last self-treatment, and 32.3%, 12 weeks following the last treatment. All the noted side effects were mild and transient. Transient erythema was noted in 47.5% of the patients. Other transient side effects reported include edema (5%), hyperpigmentation (4.75%), crusting (2.35%), hypopigmentation (1.55%), and blistering (1.4%). All noted side effects were resolved by the 12-week follow-up visit. With adequate training and instruction, patients may administer self-treatments for hair removal with this small light based unit in a safe and effective manner.
Article
Details of the use of an instrument designed to measure pulse duration and pulse profile of lasers and intense pulsed light sources are described. The unit has been found to provide clarification of pulse timing characteristics of lasers where observed characteristics were at variance with system specification. Also, the unit was found to determine output pulse characteristics of intense pulsed light (IPL) sources where definition of such pulse profiles is typically absent in supplied technical descriptions and where pulse profiles are usually more complex than that of laser systems. These measurements have allowed more accurate determination of safety criteria for the use of such systems.
Article
It is generally believed that any intervention in skin while on isotretinoin or within 6 months after the treatment can lead to prolonged healing and scarring. The objective was to evaluate the side effects of laser hair removal in patients undergoing isotretinoin treatment. Seven female patients undergoing isotretinoin therapy for acne were treated with a diode laser with a wavelength of 810 nm, a contact-cooling device, and a variable pulse width of 50 to 1000 ms. All volunteers received first treatment in the axillary or bikini area at 21 J/cm(2) (80 W) and the second treatment was done in the same area at 24 J/cm(2) (90 W). Six volunteers received additional treatments of chin area with a fluence of 21 or 24 J/cm(2). All volunteers were evaluated and photographed 1 week and 1 month after each treatment and degree of erythema, pigmentary change, vesiculation, swelling, and scarring was documented. There was no erythema, pigmentary change, swelling, or scarring at any follow up visits. One volunteer presented with a bulla 1 week after second treatment, which was resolved at 1-month follow-up. All volunteers were satisfied with the degree of hair removal with two treatments. This limited study suggests that diode laser hair removal is safe in patients undergoing isotretinoin therapy.
Article
Hair removal using lasers or broadband intense pulsed light has become one of the most ubiquitous medical procedures. At our center a small proportion of patients have spontaneously reported what they believed to be increased hair growth at sites of previous laser epilation. We sought to retrospectively review the prevalence and features of this paradoxical effect. This was a single center, retrospective study that included all patients who underwent laser hair removal during a 4-year period with a long-pulsed alexandrite laser. All cases of laser-induced hypertrichosis were assessed clinically by history, examination, and laboratory tests, and confirmed by review of serial clinical photographs taken during the course of the laser treatments. The clinical features of patients with postlaser hypertrichosis were compared with 50 patients randomly selected from among all those who had undergone laser hair removal at our center (n = 489). Of 489 patients, 3 (0.6%, 95% confidence interval: 0.01-1.9%) treated with the long-pulsed alexandrite laser (755 nm) reported increased hair after laser hair epilation. There was a trend for this adverse effect to occur in darker skin phototypes (IV) and with black hair as compared with the unaffected comparison group (n = 50). However, the small number of cases (n = 3) did not provide sufficient power to adequately test factors such as age, sex, treatment settings, and number of treatments statistically. Postlaser hair removal hypertrichosis is a real but rare occurrence in our experience.
Article
Laser hair removal is a relatively safe procedure with limited side effects. Hair induction has been previously scarcely reported. We sought to report the incidence of this strange side effect in a large number of patients treated for hair removal and to follow its course and treatment. We conducted retrospective analysis of the files of all patients who underwent laser hair removal during the time period from May 1998 until May 2005 in a private institution in Athens, Greece. Hair induction occurs predominantly on the face and neck of female patients of Mediterranean ancestry with darker skin types. The percentage is quite low (4.5%). Laser treatment of the induced hair reduces the problem. No control groups could be obtained in this study. Furthermore, the natural course of hair induction could not be studied because it was always treated or patients were lost to follow-up. Hair induction is a rare side effect of laser hair removal occurring in selected populations and body areas; however, it responds well to laser treatments.
Article
Intense pulsed light (IPL) is an effective and safe hair removal method. However, it is not exempt from side effects. To evaluate clinical and hormonal characteristics of females with facial hirsutism that developed hair growth in untreated areas close to the area submitted to IPL photoepilation ("paradoxical effect"). A total of 49 females with facial hirsutism were included in a protocol of photoepilation with an IPL source. Hyperandrogenism of tumoral origin was excluded in all subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone (OHP), and sex hormone binding globulin (SHBG) were determined prior to IPL treatment. Clinical and photographic evaluation was performed immediately before each treatment session and 2, 6, and 9 months after the last treatment session. Only cases with "paradoxical effect" were included in this study. A total of five patients with "paradoxical effect" were identified. The patients' ranged in age from 13 to 44 years and all of them had skin phototype III (Fitzpatrick scale). All these subjects were diagnosed with polycystic ovarian syndrome and presented ovarian hyperandrogenism. Patients underwent six to nine IPL sessions, and "paradoxical effect" appeared at different times during the protocol, between treatment session 3 and 6 months after the conclusion of treatment. IPL may induce activation of dormant hair follicles in untreated areas close to hirsute-treated areas.
Article
Since the theory of selective thermolysis was developed in the early 1980s, there have been numerous advances in both laser technology and the understanding of laser-tissue interaction. Nonablative dermatologic treatments involving laser light continue to be increasingly used for a number of diverse applications such as skin remodeling, the treatment of cutaneous melanocytic and vascular lesions, and the removal of undesired hair and tattoo pigment. Although these techniques are regarded as safe, both temporary and permanent adverse reactions do occur, many of which are thermally mediated. Little has been published on the frequency of adverse events in nonablative cutaneous laser treatments, or on the comparative efficacy of the various strategies commonly used to minimize them. Through reviewing relevant publications from the last 5 years, this article will address both these issues.
Article
This study examines whether intense pulsed light (IPL) treatment has a carcinogenic potential itself or may influence ultraviolet (UV)-induced carcinogenesis. Secondly, it evaluates whether UV exposure may influence IPL-induced side effects. Hairless, lightly pigmented mice (n=144) received three IPL treatments at 2-week intervals. Simulated solar radiation was administered preoperatively [six standard erythema doses (SED) four times weekly for 11 weeks] as well as pre- and postoperatively (six SED four times weekly up to 26 weeks). Skin tumors were assessed weekly during a 12-month observation period. Side effects were evaluated clinically. No tumors appeared in untreated control mice or in just IPL-treated mice. Skin tumors developed in UV-exposed mice independently of IPL treatments. The time it took for 50% of the mice to first develop skin tumor ranged from 47 to 49 weeks in preoperative UV-exposed mice (p=0.94) and from 22 to 23 weeks in pre- and postoperative UV-exposed mice (p=0.11). IPL rejuvenation of lightly pigmented skin did not induce pigmentary changes (p=1.00). IPL rejuvenation of UV-pigmented skin resulted in an immediate increased skin pigmentation and a subsequent short-term reduced skin pigmentation (p<0.002). Postoperative UV radiation resulted in re-pigmentation of IPL-induced pigment reduction (p=0.12). No texture changes were observed. Postoperative edema and erythema were increased by preoperative UV exposure (p<0.002). IPL rejuvenation has no carcinogenic potential itself and does not influence UV-induced carcinogenesis. UV exposure influences the occurrence of side effects after IPL rejuvenation in an animal model.
Article
Carlos Baptista Barcaui, MD, MSc, PhD, has indicated no significant interest with commercial supporters.
Article
Safety, efficacy and ease-of-use of a hair removal diode laser for consumer use were evaluated. The treatment group consisting of 77 appropriate users measured safety and efficacy from three self-administered treatments. The non-treatment group consisting of 44 inappropriate users measured safety from delivery of a single laser pulse. The mean hair reduction was 61% 3 weeks after the first treatment, 70% 3 weeks after the second treatment, 60% 1 month after the third treatment, 24% 2 months after the third treatment, 6% 3 months after the third treatment, 41% 6 months after the third treatment, 31% 9 months after the third treatment, and 33% 12 months after the third treatment. The only observed side effect for appropriate users was transient erythema. In simulated consumer use, the laser was highly effective at removing hair with minimal side effects for appropriate users.
Article
A 38-year-old woman underwent periocular photoepilation of upper eyelids with protective lenses. As a result of the procedure, the patient developed uveitis and a visual field defect. It is recommended that patients who wish to undergo this procedure be informed of its potential side effects.