Treatment of pseudofolliculitis barbae using the Q-switched Nd:YAG laser with topical carbon suspension

Pseudofolliculitis barbae treatment: Efficacy of topical eflornithine, long-pulsed Nd-YAG laser versus their combination

BACKGROUND

Pseudofolliculitis barbae (PFB) is a chronic inflammatory disorder occurring mostly in regions of thick hair growth after shaving. PFB is characterized clinically by multiple painful, pruritic erythematous papules and, less commonly, pustules, nodules, or abscesses.

AIM

To evaluate the efficacy of topical eflornithine cream only, long-pulsed Nd-YAG laser, versus their combination for PFB management.

PATIENTS AND METHODS

Overall, 40 male patients with PFB were allocated into 3 treatment groups; Group 1 (n = 12): Treated by topical eflornithine cream twice daily for 16 weeks, Group II (n = 13): Treated by long-pulsed Nd-YAG laser for 4 sessions 4-week interval, Group III (n = 15): Treated by this combination for 16 weeks. The patients were evaluated after 16 weeks and for a further 12 weeks through serial photographs, Folliscopic evaluation, and a quartile grading system for improvement.

RESULTS

After 16 weeks of treatments, the mean improvement percentages of the inflammatory papules, as well as hair density in the long-pulsed Nd-YAG laser +eflornithine cream, treated group were significantly higher compared with either eflornithine cream treated group or laser-only treated group. The same relationship was demonstrated after 12 weeks of follow-up but with lower improvements compared with 16 weeks of treatment outcome.

CONCLUSIONS

Topical eflornithine cream exerts an additive effect on long-pulsed Nd-YAG laser in enhancing the rate and degree of hair reduction and inflammatory papules in PFB cases with a further follow-up improvement. This combined approach should be long-established in larger sample sizes and long-term studies.

Pseudofolliculitis barbae; current treatment options

Pseudofolliculitis barbae (PFB) is a chronic inflammatory disorder of follicular and perifollicular skin characterized by papules, pustules, and post-inflammatory hyperpigmentation. It occurs more frequently in men of African and Asian descent. The etiology of PFB is multifactorial. Shaving or plucking the hair precipitates the onset of an inflammatory reaction that results from the penetration of the adjacent skin by the growing sharp tips. The curved shape of the hair follicle allows for the downward curvature and penetration of the growing hair tips into the skin. The onset of the foreign body reaction leads to itching and the development of papules, pustules, and post-inflammatory hyperpigmentation, especially in the beard area although other shaved areas of the body may be affected. Keloids have also been known to develop after the onset of PFB, giving rise to extensive unsightly scars. Diagnosis is clinical. Cessation of shaving or removal of the involved hair follicles usually terminates the development of PFB. Individuals with the single nucleotide substitution in the hair follicle companion layer specific keratin gene (K6hf) have a six fold increased chance of developing PFB.

Laser treatment of acne vulgaris

Traditional medical treatments for acne vulgaris include a variety of topical and oral medications. The combination of poor compliance, lack of durable remission, and potential side effects are common drawbacks to these treatments. The use of lasers and light devices has increased dramatically in recent years due to the overall ease of treatment, predictable clinical efficacy, and minimal adverse effects. A variety of light and laser devices has been used for the treatment of acne, including the potassium titanyl phosphate (KTP) laser, the 585- and 595-nm pulsed dye lasers, the 1450-nm diode laser, radiofrequency devices, intense pulsed light sources, low-intensity light treatment, and photodynamic therapy using 5-aminolevulinic acid and indocyanine green. These devices are thought to target underlying pathogenic factors such as Propionibacterium acnes colonization, increased sebaceous gland activity, and the cutaneous inflammatory response. Lasers in particular also have a central role in the management of acne scarring, which tends to be refractory to medical therapies. Fractional photothermolysis, the 1450-nm diode laser, and pulsed dye lasers have been used in the nonablative treatment of acne scars with significant success. In this article, we review the current status of light- and laser-based treatment of acne and related conditions and briefly review the use of lasers for the treatment of acne scarring.

Comparative evaluation of long pulse Alexandrite laser and intense pulsed light systems for pseudofolliculitis barbae treatment with one year of follow up

Background:

Existing remedies for controlling pseudofolliculitis barbae (PFB) are sometimes helpful; however the positive effects are often short lived. The only definitive cure for PFB is permanent removal of the hair follicle.

Aims:

Our aim was to compare the efficacy of the Alexandrite laser with the intense pulsed light system in the treatment of PFB and to follow up the recurrence.

Methods:

Twenty male patients seeking laser hair removal for the treatment of PFB were enrolled in this study. One half of the face was treated with the long-pulse Alexandrite laser and the other half was treated with the IPL system randomly. The treatment outcome and any complications were observed and followed up for one year.

Results:

All patients exhibited a statistically significant decrease in the numbers of papules. Our results showed that the Alexandrite-treated side needed seven sessions to reach about 80% improvement, while the IPL-treated side needed 10-12 sessions to reach about 50% improvement. During the one year follow up period, the Alexandrite-treated side showed recurrence in very minimal areas, while the IPL-treated side showed recurrence in bigger areas.

Conclusions:

Our results showed that both systems might improve PFB but Alexandrite laser was more effective at reducing PFB than IPL.

Site-specific methylene blue delivery to pilosebaceous structures using highly porous nylon microspheres: an experimental evaluation

PURPOSE

This study aimed to evaluate the penetration of methylene blue (MB)-loaded microspheres into pilosebaceous structures of rats.

MATERIALS AND METHODS

MB was incorporated into 5 microm highly porous nylon microspheres. The microspheres were dispersed into fluid silicone. Male hairless rats were used to evaluate the penetration of MB into hair follicles. After formulation application, MB diffusion was induced and skin biopsies were realized immediately, 2 and 26 hours after MB loaded microspheres application. MB fluorescence was observed with a microscope expanded for fluorescence microscopy.

RESULTS

Position of microspheres and MB diffusion was dependent on delay between microspheres application and harvest. Inside the skin, MB was seen exclusively in the hair follicle and the sebaceous glands. MB diffusion varied from 160+/-50 microm (2 hours after application) to 410+/-70 microm (26 hours after application). MB was also found in the sebaceous glands.

DISCUSSION

This study confirms that 5 micro m microspheres are optimally deposited deep within the pilosebaceous structure. In agreement with the literature, when microspheres are topically applied on the skin, they penetrate via a "lipid-rich channel" coating the hair follicles. MB is exclusively distributed in the hair follicles and their accessories.

CONCLUSION

This report presents evidence of MB pilosebaceous delivery through the use of microsphere formulation. This is obtained thanks to topical enhancement via the follicular route. This drug delivery system aims to transport MB into the pilosebaceous unit specifically and deeply. Various other applications could derive from this work. For example, such a method might be used to increase the therapeutic index of drugs directed at hair sebaceous gland disorders. Laser treatment of acne or laser hair removal could also benefit of this technique.

Treatment of pseudofolliculitis barbae in skin types IV, V, and VI with a long-pulsed neodymium:yttrium aluminum garnet laser

BACKGROUND

Pseudofolliculitis barbae affects a large number of individuals with coarse curly hair, and present treatment options are suboptimal.

OBJECTIVE

We evaluated the safety and efficacy of a long-pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser in the treatment of pseudofolliculitis barbae.

METHODS

This was a two-phase observational study conducted at a military tertiary medical facility. The study group included 37 patients (skin types IV, V, and VI) referred from primary care physicians with a diagnosis of pseudofolliculitis barbae refractory to conservative therapy. In phase I, one treatment with a Nd:YAG laser was performed on a tattooed area of the thigh with 3 light doses. Epidermal tolerance was evaluated, and hair counts were performed 3 months after treatment for each light dose. In phase II, the highest dose tolerated by the epidermis from phase I was applied to a small submental region of skin with an adjacent site as a control. Subsequently, papule counts were performed 90 days after treatment in the laser-irradiated and control areas.

RESULTS

Phase I: When normalized for controls, there was 33%, 43%, and 40% hair reduction on the thigh for the 50, 80, and 100 J/cm(2) fluences, respectively, after 90 days. Overall, the highest doses tolerated by the epidermis were 50, 100, and 100 J/cm(2) for type VI, V, and IV skin, respectively. Phase II: Mean papule counts after 90 days were 6.95 and 1.0 for the control and treatment sites, respectively.

CONCLUSION

Nd:YAG laser treatment may represent a safe and effective option for reducing hair and subsequent papule formation in patients with pseudofolliculitis barbae.