Laser hair removal: a review

Restorative oncodermatology: Diagnosis and management of dermatologic sequelae from cancer therapies

The long-term survival of patients with cancer has risen dramatically during the last few decades. Despite this remarkable success, the same treatments that have enabled cure or remission often secondarily affect the skin, hair, and nails. Conditions including scarring, striae distensae, persistent alopecia, pigmentary changes, nail alterations, chronic radiation dermatitis, and radiation fibrosis have been associated with anxiety, depression, decreased quality of life, and impaired function. These dermatologic changes are cosmetically disfiguring, may limit activities, and are a visual reminder of past illness. Interventions toward improving these untoward sequelae and restoring the appearance and function of skin and appendages are critical for normalization and may contribute to improved quality of life in cancer survivors. Here, we outline dermatologic sequelae of cancer therapies with a review of medical and procedural treatment strategies to restore dermatologic health in the survivorship population.

Complications of laser hair removal-How we could reduce them?

Laser hair removal became a very popular intervention, with a permanently increasing number of procedures being performed worldwide. The procedure is often performed by nonmedical personnel, and even by untrained personnel, that could be associated with different kind of adverse events, from mild to serious. The complications associated could be lower if the operators understand the basic of laser physics and the working principles of devices. We propose a simple acronym, WATCH, in order to increase the safety and efficiency of laser interventions.

Laser Treatment in Hirsutism: An Update

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.

Diode Laser 805 Hair Removal Side Effects in Groups of Various Ethnicities - Cohort Study Results

Introduction: As hair removal has become most popular in aesthetics, the management of its side effects is crucial for every practitioner. Available studies describe the effectiveness of the diode laser hair removal for all skin types according to the Fitzpatrick scale independently, but the question of the occurrence of side effects and adverse effects remains unanswered. This study aims to illustrate aspects of side effects for patients of various ethnicities and the impact of those on the effectiveness of the treatment. Methods: The research was carried out in Poland and the United Kingdom from March 2016 to March 2019. 217 people of various ethnic origins were qualified for the study, 206 sessions were completed and statistical analysis was performed. The procedure was performed in the pubic area with diode lasers with a wavelength of 805 nm, minimum peak power of 2100 W and pulse duration between 15 and 400 ms. ET sapphire cooling assisted handle 9 x 9 mm large and pulse energy density between 10 and 100 J/cm² were used for all treatments. In addition, in order to illustrate the effectiveness of treatments, the subjective and objective analyses of hair loss percentages were indicated. In statistical analysis, the chi-square test for independence was used to evaluate the correlation between the type and severity of side effects and the ethnic origin of patients, the number of treatments, the Fitzpatrick scale and the level of satisfaction. Results: The occurrence of sensitivity depended statistically significantly (PP=0.002) on ethnicity. Ethnicity had no significant effect on the occurrence of erythema. The occurrence of hyperpigmentation statistically significantly depended (P<0.001) on ethnicity. The occurrence of burns depended statistically significantly (P=0.001) on ethnicity. The number of treatments had a significant (P P=0.012) effect on the severity of side effects occurrence. Among participants who had 6 treatments, only half had side effects, including multiple effects occurring in 9.79% of cases. The occurrence of side effects such as sensitivity and hyperpigmentation did not depend on the number of treatments. However, the number of treatments had a significant impact on the incidence of erythema (P<0.001) and burns (P=0.005). More than half of the respondents (58.33%) had erythema after more than six procedures, whereas in the 6 treatments the erythema occurred only in 6.7% of cases. Conclusion: The treatment with the use of diode lasers for all subjects with different ethnicity and thus the recognized scale according to Fitzpatrick is effective and safe. The occurring side effects are transient and do not impact the effect of the whole therapy.

The qualification and training of laser/intense pulse light hair removal operators within South Africa

BACKGROUND

Lasers and intense pulse light (IPL) sources are powerful devices that can cause skin burns, pigmentary changes, and scarring if used incorrectly. Adequate training is essential, and regulations are required to limit complications.

AIMS

The purpose was to investigate the qualifications and training obtained by laser hair removal operators in South Africa.

METHODS

Questionnaires were distributed and information gathered from owners/managers of laser clinics, suppliers of laser devices in South Africa, individuals in the workplace performing laser hair removal procedures, and accredited tertiary institutions.

RESULTS

A majority of clinic owners/managers (94.45%) felt that more emphasis should be placed on laser hair removal training at a tertiary level, and 66.67% outsource additional training provided by the manufacturer of laser devices. Based on the survey to manufacturers, 50% did not require any formal qualification as a minimum requirement, while 33.33% indicated laser hair removal training is incorporated at a NQF level 4 (National/Senior Certificate). The majority of individuals (68.89%) received training from tertiary institutions; however, they did not receive any practical training, and 60.87% felt the amount of training was insufficient. According to the survey sent to tertiary institutions in South Africa, only 27.78% offer laser hair removal training, and of these, 20% offer no practical training and 50% indicated that no practical examination is provided.

CONCLUSIONS

There is a clear lack of training in laser hair removal in South Africa. The industry should have standard requirements in terms of minimum practical and theoretical hours with regards to the therapy.

Lasers for reduction of unwanted hair in skin of colour: a systematic review and meta-analysis

Light-based therapies are one of the most effective and widely used strategies for removal of undesired hair, with a broadly favourable 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 colour. 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 (nine randomized controlled trials and three 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 [standardized mean difference (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 postinflammatory 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 towards greater hair reduction following laser therapy compared with IPL.

Intense pulsed light treatment for Becker's nevus

BACKGROUND

Becker's Nevus (BN) is a benign hamartoma with an esthetically troublesome condition secondary to hyperpigmentation and hypertrichosis. Many treatment modalities have been utilized with variable outcomes.

OBJECTIVES

To evaluate the efficacy and safety of intense pulsed light (IPL) in the treatment of BN.

PATIENTS AND METHODS

IPL was used at filter of 590 nm, fluence of 18-22 J/cm², double-pulse mode (pulse width of 3-10 ms, pulse delay of 20-30 ms) at 3-month intervals. Final evaluations were performed by physician global assessment and patient satisfaction. Side effects were monitored at each treatment session and follow-up visit.

RESULTS

Twenty-four patients (9 females, 15 males) with BN (16 hypertrichotic, 8 atrichotic) completed the study. The mean number of treatment sessions was 5 ± 2.17. The improvement in atrichotic BN group (4.87 ± 0.35) was significantly greater than that observed in hypertrichotic BN group (3.63 ± 0.89) (p = .001). Hair density simultaneously decreased with treatment in hypertrichotic BN. The mean satisfaction score was 5.75 ± 2.05 and 8 ± 0.93 in hypertrichotic and atrichotic BN groups respectively (p = .002). No repigmentation was noted during the follow-up period. No permanent side effects were observed.

CONCLUSIONS

IPL is an effective and well-tolerated treatment option for patients with hypertrichotic and atrichotic BN.

North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management

Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.

Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls

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.

Inadvertent macular burns and consecutive psychological depression secondary to Alexandrite laser epilation: A case report

Unwanted hair is an important aesthetic problem in many cultures. Laser epilation devices have become commonly available at the present time. Nowadays, laser hair removal is widely practiced as a cosmetic procedure, however, some ocular complications may occur. The retina is the most vulnerable to laser-related injury which can lead to serious visual impairment. Laser epilation can cause serious complications and medical costs if not performed carefully and appropriately. The use of laser hair removal devices by unskilled aestheticians who is untrained and do not have the proper protective equipment at the beauty centers, can cause serious ophthalmological and psychological disorders and thus substantial labour productivity loss and economic loss. Therefore, the protective eyewear must be used by both the aesthetician and the patient during the procedure of laser epilation. In this way, we can improve the safety of both patients and aestheticians and at the same time ensure their healths. I reported the case of a 49-year-old female with a unilateral maculopathy responsible for an acute visual field defect and consecutive psychological depression secondary to Alexandrite laser epilation. This report is important to raise the awareness of ophthalmology and dermatology society and public about risks of their misuse.

Enhanced laser surface ablation with an integrated photoacoustic imaging and high intensity focused ultrasound system

BACKGROUND AND OBJECTIVE

Combined laser and ultrasound treatments have been found to have synergistic effects, which may be of particular note in dermatology. We aim to investigate the potential of this technology for dermatology through in vitro and ex vivo experiments.

METHODS

In vitro tissue phantoms made of agar and tattoo ink and tattooed ex vivo chicken breast tissue were used. An integrated photoacoustic imaging and high intensity focused ultrasound (HIFU) system, using a 5-ns tunable OPO laser system and a 5 MHz HIFU transducer, was used to perform photoacoustic analysis to identify the optical contrast, and perform combined laser and ultrasound ablation. On the tissue phantoms, lines of ablation were created under various operating conditions. The samples were then quantified to determine the level of ablation. Same procedures were performed on the tattooed chicken breast tissue and the tattoo was removed by using combined laser and ultrasound.

RESULTS

Ablation in the in vitro tissue phantoms was observed with properly synchronized laser and ultrasound while no ablation was found with either laser or ultrasound alone. Increases to the intensity or pulse duration of ultrasound caused an increase in ablation to the samples. The tattoo was removed from the ex vivo chicken breast using combined laser and ultrasound with a radiant exposure of 1.2 J/cm² while laser and ultrasound alone were unable to remove the tattoo.

CONCLUSIONS

We determined that by supplementing nanosecond laser pulses with ultrasound, ablation, and tattoo removal can be achieved at laser radiant exposures levels would otherwise be ineffective. The area of ablation can be adjusted through changes in the intensity and duration of the ultrasound burst with a constant laser intensity. Additionally, the system can be used to perform photoacoustic analysis of the tissue to estimate the relative optical absorbance at various available wavelengths, allowing for pretreatment analysis. Lasers Surg. Med. 9999:1-9, 2019. © 2019 Wiley Periodicals, Inc.

Aspects of Diode Laser (805 nm) Hair Removal Safety in a Mixed-Race Group of Patients

Introduction: Laser hair removal (LHR) has become one of the most popular treatments in aesthetics. Side effects are an inevitable part of laser therapy, therefore managing them is crucial for every laser practitioner to ensure patients' safety along with achieving the best results. The available references describe the effectiveness of the diode LHR for all skin types according to the Fitzpatrick scale, but the question of patient safety and minimization of side effects and postoperative complications in mixed-race patients remains unanswered. This study aims to illustrate aspects of specific side effects in patients of mixed ethnicity and the impact of those effects on the results of the treatment. Methods: The study was conducted in Poland and the United Kingdom on 216 patients of various ethnic backgrounds. This study analyses the frequency of side effects in a mixed-race group of 32 participants, taking into account their skin type according to the Fitzpatrick scale. The patients received a course of 6 treatments using diode laser 805 nm. An objective and a subjective method were used to analyse treatment results and side effects, with adverse effects documented, if observed. Treatment settings were adjusted to skin reaction during the patch test. Results: Objective analysis was different from the subjective analysis of the treatment's effectiveness. No adverse effects were observed. Side effects such as hyperpigmentation, skin irritation, skin burns, and skin hypersensitivity were found. Conclusion: 805 nm diode laser is effective and efficient at hair removal in mixed-race patients. It is a safe treatment in terms of skin reaction as only short-term side effects were observed in the treated area and no adverse effects were noted. To achieve the best results and to avoid adverse effects it is necessary to adjust treatment settings according to the individual patient's skin reaction.

A Single-Blind Study Evaluating the Efficacy of Gold Nanoparticle Photothermal-Assisted Liposuction in an Ex Vivo Human Tissue Model

BACKGROUND

Liposuction is one of the most performed cosmetic surgery procedures. In a previously reported study, gold-nanoparticle (GNP) laser-assisted liposuction (NanoLipo) was shown to improve procedure parameters and outcomes in a porcine model.

OBJECTIVES

An ex vivo human liposuction model was developed to assess the ease, efficacy, and outcomes of NanoLipo, and to further explore its mechanism of action in facilitating liposuction.

METHODS

NanoLipo was compared to a control without GNPs in sets of fresh, nonperfused, anatomically symmetric, matched tissue specimens from 12 patients. A subset of three experiments was performed under single-blinded conditions. Intraoperative assessments included lipoaspirate volume, percentage of free oil, ease of removal, and temperature rise. Specimens were palpated, visualized for evenness, and graded with and without skin. Postoperative assessment included viability staining of the lipoaspirate and remaining tissues. Microcomputed tomography was used to assess the distribution of infused GNPs within the tissues.

RESULTS

NanoLipo consistently removed more adipose tissue with more liberated triglycerides compared to control. NanoLipo specimens were smoother, thinner, and had fewer and smaller irregularities. Infused solutions preferentially distributed between fibrous membranes and fat pearls. After NanoLipo, selective structural-tissue disruptions, indicated by loss of metabolic activity, were observed. Thus, NanoLipo likely creates a bimodal mechanism of action whereby fat lobules are dislodged from surrounding fibro-connective tissue, while lipolysis is simultaneously induced.

CONCLUSIONS

NanoLipo showed many advantages compared to control under blinded and nonblinded conditions. This technology may be promising in facilitating fat removal.

LEVEL OF EVIDENCE 5

Randomized, side-by-side comparison of a topical photo-enhancer gel for hair removal: an efficacy and safety study

Background: Novel protocols are evolving to enhance hair follicle damage while preserving safety and improving efficacy. Objectives: The safety and tolerability of a 755-nm diode laser was compared to a combined laser with topical photo-enhancer gel ("combined") versus laser alone ("solo"). Methods: Twenty women (age 23-33 years old), Fitzpatrick skin type I-V, were randomized to side-by-side comparisons with a laser hair removal protocol. The combined side received reduced laser energy compared to the solo side. The laser used in-motion super hair removal technology. Subjects received up to four treatments. Subjects were assessed at baseline and at 1 and 6 months after the last treatment. Results: At the 1-month follow-up, there were no statistical differences in percent hair reduction between the combined (81 ± 16%) versus the solo (77 ± 15%) protocols (p > 0.05). Similarly, at 6-month follow-up, there are no statistical differences between the combined (71 ± 24%) versus the solo (70 ± 23%) treatment protocols (p > 0.05). The average accumulative laser energy in the combined side was half of the solo side (4.2 ± 1.6 vs. 7.6 ± 2.7 kJ, respectively). Pain during the procedure was significantly higher in the solo (5.5 ± 1.8) versus the combined (3.8 ± 1.7) protocol (p < 0.001). Conclusion: A laser hair removal paradigm that combines a 755-nm diode laser with a photo-enhancer gel (reduced kJ protocol) is clinically effective as a solo treatment protocol.

The Combination of Expanded Scalp Flap and 800 nm Diode Laser in the Reconstruction of Forehead Defect

Skin grafting is often the first choice for closing forehead defects. However, the aesthetics of skin grafting-reconstructed forehead defects are still not accepted by a large number of patients. With the technological advancement of laser hair removal, scalp flaps have been considered as donors for reconstruction of forehead defects. We evaluated 10 cases of forehead defect reconstructions with expanded scalp flaps followed by hair removal by an 800 nm diode laser. All flaps survived uneventfully and underwent 4-6 laser treatments for hair removal. The appearances of the reconstructed foreheads were similar to that of the adjacent skin, and all patients were satisfied with the treatment outcomes during the 6-24 months of follow-up. It is concluded that the combined treatments of expanded scalp flaps and diode laser hair removal are effective for repairing forehead defects.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Solid-Phase Synthesis of Peptide-Conjugated Perylene Diimide Bolaamphiphile and Its Application in Photodynamic Therapy

Here, we describe a rapid and efficient synthetic method of peptide-conjugated perylene diimide (P-PDI) using solid-phase peptide synthesis (SPPS). Due to severe insolubility of perylene dianhydride (PDA) as a starting material of perylene diimide (PDI), PDA was initially conjugated with amino acids to obtain soluble PDI derivatives. Target peptides were synthesized on a 2-chlorotrityl chloride resin using the SPPS method and then conjugated with the amino acid-appended PDI. Various conditions such as loading levels, reaction times and solvents were optimized for introducing the peptides to both sides of the amino acid-appended PDI. The final P-PDI was obtained with a maximum yield of 80% in 12 h. Its singlet oxygen-derived phototoxicity on cells was confirmed, which could be applicable to photodynamic therapy.

Laser and Light Treatments for Hair Reduction in Fitzpatrick Skin Types IV-VI: A Comprehensive Review of the Literature

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.

Purpura induced by laser hair removal: a case report

Background

Laser hair removal is an effective and safe method for the permanent reduction of unwanted hair. Common side effects include temporary pain, transient erythema, and perifollicular edema. Purpuric eruption is a rare adverse event.

Case presentation

To the best of our knowledge, this is the second case report of purpura induced by laser hair removal. Our patient is a 50-year-old woman of Arab origin. Her positive reaction to a laser hair removal provocation test helped in the diagnosis; her condition was managed with an orally administered corticosteroid, leading to complete resolution within 5 days.

Conclusion

Purpura induced by laser hair removal is a self-limiting and unusual side effect; physicians’ awareness of such adverse events can help them to avoid unnecessary investigations and provide guidance for better management.

A Hairy Situation: Laser Hair Removal after Oral Reconstruction

OBJECTIVES

To present a case series of 4 patients who underwent postoperative hair removal using the long-pulsed Alexandrite or Nd:YAG laser following intraoral cutaneous flap reconstruction.

METHODS

Patients underwent epilation in dermatology clinic with long-pulsed Alexandrite or Nd:YAG lasers, spaced 8 weeks apart, until hair removal was achieved.

RESULTS

All patients achieved improvement in hair removal regardless of initial flap donor site with significant improvement in quality of life and minimal side effects.

CONCLUSIONS

The long-pulsed Alexandrite and Nd:YAG represent safe and effective treatment options to improve patient quality of life following intraoral flap repair following excision of malignancy.

Ocular injuries secondary to alexandrite laser-assisted hair removal

PURPOSE

The aim of this study was to describe the clinical manifestations and outcomes of 4 patients who had sustained eye injury during alexandrite laser-assisted hair removal.

METHODS

This was a retrospective case series of 4 patients who presented to 2 tertiary eye care hospitals over 2 years. Data on ophthalmic examination, spectral domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany), and fundus fluorescein angiography were collected.

RESULTS

Four female patients sustained injuries during alexandrite laser hair removal. One patient presented with acute anterior uveitis, 2 patients with subfoveal choroidal neovascularization, and 1 patient with intraretinal foveal hemorrhage. Visual acuity at last follow-up (range 3-6 months) was 20/15 to 20/20.

CONCLUSIONS

Ocular injuries can occur as a result of incorrect use of laser-assisted hair removal devices. Ophthalmologists should be aware of ocular damage caused by these devices.

Static and dynamic modes of 810 nm diode laser hair removal compared: A clinical and histological study

BACKGROUND AND AIMS

Laser hair removal has recently become a major indication. Diode lasers have become commercially available offering two modes of application: a stamping or static mode, and a dynamic mode whereby the handpiece is continuously moved across the target tissue. The present study was designed to compare the efficacy of these two approaches clinically and histologically.

SUBJECTS AND METHODS

Twenty-five subjects participated in the study, 12 males and 13 females, ages ranging from 20 to 57 yr (Mean age 41.6 yr). A baseline hair count was performed on both the target areas. The ms-pulsed diode laser delivered 810 nm via a handpiece with a cooled tip, offering both static and dynamic modes which were used on the subjects' left and right crura, respectively. Pain during treatment was assessed using a visual analog scale (VAS) and gross inspection was performed immediately after treatment for any abnormality in the treated skin. Hair counts were performed on both crura at 1 and 3 months after the treatment, and compared with the baseline counts. Biopsies were performed in the dynamic mode treated skin at baseline and at 1 month after the treatment, and assessed with light microscopy, immunohistochemistry and transmission electron microscopy (TEM).

RESULTS

All subjects completed the study. Compared with baseline, hair counts were significantly lower at 1 and 3 months post-treatment with no significant difference between the static and dynamic laser depilation modes, nor in the severity of the pain experienced during the procedure. Histologically, degenerative changes in the hair follicles were noted immediately after laser treatment. At one month, cystic formation was seen in the hair follicles showing a strong tendency towards apoptotic cell death.

CONCLUSIONS

With the diode laser system and at the parameters used in the present study, high depilation efficacy was seen with no significant difference between the static and dynamic modes. Interestingly, good long-term depilation is probably a result of induced apoptotic cell death in the follicles rather than any other mechanism.

Laser-induced synlabia, cryptomenorrhea, and urine retention: A case report and literature review

Cosmetic laser use has many pros and cons. The worldwide use of laser for body hair removal has led to many medical complications. Unsupervised use of the laser for hair removal in vulva may result in many problems and can merely damage the vulva, although rarely, affecting the body image. This rare and novel case report is a 21 year old virgin who presented with acute urinary retention and cryptomenorrhea due to complete synlabia secondary to unsupervised vulval laser hair removal. The urinary retention was relieved by suprapubic catheterization initially. During examination under anesthesia, the fused labia were separated by a surgical incision with drainage of hematocolpos and then, a Foley's urethral catheter was inserted. She had an uneventful recovery. We report this case to emphasize on the supervised use of laser by trained and qualified personnel for hair removal in vulva to minimize its complications.

Development of a Novel Automated Hair Counting System for the Quantitative Evaluation of Laser Hair Removal

OBJECTIVE

We aimed to develop and validate a novel computer-assisted automated hair counting system for the quantitative evaluation of laser hair removal (LHR).

METHODS

We developed a computer-aided image processing system to count hairs on shaved skin and validated its performance through clinical trials. Five volunteers of Fitzpatrick skin type III-IV volunteered and were tested on both thighs. The system automatically detects hair and places a "+" sign on each hair site for every positive detection. This method allows clinicians to check whether a hair has been counted or not. We analyzed the difference in the hair counts between the proposed system (automatic) and those by human observers (manual).

RESULTS

The hair counts from the proposed system and the manual counts were compared. The percentage error between automatic and manual counting was <5% in each subject. The data of the two groups were statistically verified with Student's independent t-test. The averages were statistically equivalent between the two groups. The proposed system showed significant time saving in terms of counting.

CONCLUSIONS

A dependable, accurate, and fast method of counting hairs on shaved skin through a computer-aided image processing system was developed and validated. The "+" signs on the image to indicate detection allows clinicians to compare with the original image and detect any omission or redundancy. The proposed system is expected to be reliable in analyzing the results of multiple skin-related treatments, including LHR and hair transplantation. Further, it is expected to be widely applicable for use in the clinic.

Laser hair removal for genital gender affirming surgery

Genital gender affirming surgery (GAS) involves reconstruction of the genitals to match a patient’s identified sex. The use of hair-bearing flaps in this procedure may result in postoperative intra-vaginal and intra-urethral hair growth and associated complications, including lower satisfaction with genital GAS. Despite the significant increase in genital GAS within the past 50 years, there is limited data regarding hair removal practices in preparation for genital GAS and notable variation in hair removal techniques among dermatologists and other practitioners. We present a literature review, recommendations from our experience, and a practical laser hair removal (LHR) approach to hair removal prior to genital GAS.

Pain management in photoepilation

The hair follicle is a complex, hormonally active structure with permanent and cyclically renewed parts which are highly innervated by myelinated and unmyelinated afferent fibers. Hair removal, a very ancient practice, affects this sensory network and causes both acute and diffuse pain associated with inflammatory reaction. Optic permanent hair removal is becoming a popular alternative to traditional methods such as shaving, waxing, among other methods. These optical removal devices thermally destroy the target chromophore, that is, melanin, without damaging the surrounding skin. The increase in the skin surface temperature causes mild-to-severe pain, and optical hair removal has to be combined with pain relieving devices. Pain management relies on topical anesthetic agents, cooling devices, or non-noxious cutaneous stimulation whose mechanisms of action and efficiency are discussed in this article.

Efficacy and Safety of Hair Removal with a Long-Pulsed Diode Laser Depending on the Spot Size: A Randomized, Evaluators-Blinded, Left-Right Study

BACKGROUND

The efficacy of the long-pulsed diode laser (LPDL) in hair removal is determined with various physical parameters. Recently, LPDLs with a larger spot size are commercially available; however, the independent effect of spot size on hair removal has not been studied.

OBJECTIVE

This study aimed to compare the efficacy of the LPDL in hair removal depending on the spot size.

METHODS

A randomized, evaluators-blind, intrapatient comparison (left vs. right) trial was designed. Ten healthy Korean women received three hair removal treatment sessions on both armpits with the 805-nm LPDL and followed for 3 months. A 10×10 mm handpiece (D1) or a 10×30 mm handpiece (D3) was randomly assigned to the right or left axilla. The fluence, pulse duration, and epidermal cooling temperature were identical for both armpits. Hair clearance was quantified with high-resolution photos taken at each visit. Postprocedural pain was quantified on a visual analogue scale. Adverse events were evaluated by physical examination and the patients' self-report.

RESULTS

The mean hair clearance at 3 months after three treatment sessions was 38.7% and 50.1% on the armpits treated with D1 and D3, respectively (p=0.028). Procedural pain was significantly greater in the side treated with D3 (p=0.009). Serious adverse events were not observed.

CONCLUSION

Given that the pulse duration, fluence, and epidermal cooling were identical, the 805-nm LPDL at the three times larger spot size showed an efficacy improvement of 29.5% in axillary hair removal without serious adverse events.

Comparison of Efficacy Between Novel Robot-Assisted Laser Hair Removal and Physician-Directed Hair Removal

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.

Fixed, low radiant exposure vs. incremental radiant exposure approach for diode laser hair reduction: a randomized, split axilla, comparative single-blinded trial

BACKGROUND

Diode lasers are the most commonly used treatment modalities for unwanted hair reduction. Only a few controlled clinical trials but not a single randomized controlled trial (RCT) compared the impact of various laser parameters, especially radiant exposure, onto efficacy, tolerability and safety of laser hair reduction.

OBJECTIVE

To compare the safety, tolerability and mid-term efficacy of fixed, low and incremental radiant exposures of diode lasers (800 nm) for axillary hair removal, we conducted an intrapatient, left-to-right, patient- and assessor-blinded and controlled trial.

METHODS

Diode laser (800 nm) treatments were evaluated in 39 study participants (skin type II-III) with unwanted axillary hairs. Randomization and allocation to split axilla treatments were carried out by a web-based randomization tool. Six treatments were performed at 4- to 6-week intervals with study subjects blinded to the type of treatment. Final assessment of hair reduction was conducted 6 months after the last treatment by means of blinded 4-point clinical scale using photographs. The primary endpoint was reduction in hair growth, and secondary endpoints were patient-rated tolerability and satisfaction with the treatment, treatment-related pain and adverse effects.

RESULTS

Excellent reduction in axillary hairs (≥ 76%) at 6-month follow-up visit after receiving fixed, low and incremental radiant exposure diode laser treatments was obtained in 59% and 67% of study participants respectively (Z value: 1.342, P = 0.180). Patients reported lower visual analogue scale (VAS) pain score on the fixed (4.26) than on the incremental radiant exposure side (5.64) (P < 0.0003). The only side-effect was mild and transient erythema. Subjects better tolerated the fixed, low radiant exposure protocol (P = 0.03). The majority of the study participants were satisfied with both treatments.

CONCLUSION

Both low and incremental radiant exposures produced similar hair reduction and high and comparable patient satisfaction. However, low radiant exposure diode laser treatments were less painful and better tolerated.

Laser and energy-based devices' complications in dermatology

Laser dermatology is an ever-expanding part of the specialty used extensively for both aesthetic and medical conditions. Advances in laser technology have led to an expansion in the number of devices available, with as a consequence an increase in the total number of complications. Fortunately, the current technology has improved greatly which adds to the safety profile of such devices; nevertheless, thorough knowledge of laser complications and how to avoid them is paramount for any practitioner who uses such technology.

Congenital generalized hypertrichosis: the skin as a clue to complex malformation syndromes

Hypertrichosis is defined as an excessive growth in body hair beyond the normal variation compared with individuals of the same age, race and sex and affecting areas not predominantly androgen-dependent. The term hirsutism is usually referred to patients, mainly women, who show excessive hair growth with male pattern distribution.Hypertrichosis is classified according to age of onset (congenital or acquired), extent of distribution (generalized or circumscribed), site involved, and to whether the disorder is isolated or associated with other anomalies. Congenital hypertrichosis is rare and may be an isolated condition of the skin or a component feature of other disorders. Acquired hypertrichosis is more frequent and is secondary to a variety of causes including drug side effects, metabolic and endocrine disorders, cutaneous auto-inflammatory or infectious diseases, malnutrition and anorexia nervosa, and ovarian and adrenal neoplasms. In most cases, hypertrichosis is not an isolated symptom but is associated with other clinical signs including intellective delay, epilepsy or complex body malformations.A review of congenital generalized hypertrichosis is reported with particular attention given to the disorders where excessive diffuse body hair is a sign indicating the presence of complex malformation syndromes. The clinical course of a patient, previously described, with a 20-year follow-up is reported.

Trial of human laser epilation technology for permanent wool removal in Merino sheep

OBJECTIVE

To assess whether human laser epilation technology can permanently prevent wool growth in sheep.

DESIGN

An observational study.

METHODS

Two commercial human epilation lasers (Sharplan alexandrite 755 nm laser, and Lumenis LightSheer 800 nm diode laser) were tested at energies between 10 and 100 J/cm2 and pulse widths from 2 to 400 ms. Wool was clipped from flank, breech, pizzle and around the eyes of superfine Merino sheep with Oster clippers. After initial laser removal of residual wool to reveal bare skin, individual skin sites were treated with up to 15 cycles of laser irradiation. Behavioural responses during treatment, skin temperature immediately after treatment and skin and wool responses for 3 months after treatment were monitored.

RESULTS

A clear transudate was evident on the skin surface within minutes. A dry superficial scab developed by 24 h and remained adherent for at least 6 weeks. When scabs were shed, there was evidence of scarring at sites receiving multiple treatment cycles and normal wool growth in unscarred skin. There was no evidence of laser energy level or pulse width affecting the response of skin and wool to treatment and no evidence of permanent inhibition of wool growth by laser treatment. Laser treatment was well tolerated by the sheep.

CONCLUSIONS

Treatment of woolled skin with laser parameters that induce epilation by selective photothermolysis in humans failed to induce permanent inhibition of wool growth in sheep. Absence of melanin in wool may have contributed to the result.