Skin pigmentation and texture changes after hair removal with the normal-mode ruby laser

Laser- and light-based hair removal: an update

A variety of laser technologies are now able to successfully remove unwanted hair. Successful removal is based on an understanding of laser physics and appropriate wavelengths, pulse durations and cooling of the skin. Although ruby lasers were among the first to be used, alexandrite, diode and neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers, as well as a variety of broad-spectrum intense pulsed light sources, are currently more commonly used for the treatment of unwanted hair. Darker skin types are more difficult to treat but can also be treated. Complications can occur after laser hair removal but can be reduced through an understanding of the fundamentals of laser removal. These complications include the obvious, such as scarring and pigmentary changes, and the not so obvious, such as reticulate erythema and uveitis. Laser hair removal is now widely accepted as a successful approach to remove unwanted hair in both men and women. The future will involve office-based laser and light source hair removal, as well as a variety of laser and light-based home devices.

Hair reduction using a new intense pulsed light irradiator and a normal mode ruby laser

OBJECTIVE

The main purpose of this clinical study was to compare the effectiveness of an intense pulsed light irradiator system (IPL) and a normal mode ruby laser for hair removal.

MATERIALS AND METHODS

Thirty-one patients were treated 3 times with a new IPL system on one side of the chin and neck and with a normal mode ruby laser on the other side. After 6 months, nine of the patients received 3 additional IPL treatments and 11 patients received 3 additional ruby laser treatments. All treatment intervals were 2 months. Hair reduction was measured by hair counts on close-up photographs.

RESULTS

Hair reduction was obtained by 93.5% of the patients after 3 IPL treatments and by 54.8% after 3 ruby laser treatments. The average hair count was reduced by 49.3% after IPL treatments and by 21.3% after ruby laser treatments. Three additional IPL treatments following 3 IPL treatments resulted in only 6.6% further hair reduction--in total 55.9%, whereas 3 IPL treatments following 3 ruby laser treatments resulted in an additional 35.5% hair reduction--in total 56.8%.

CONCLUSIONS

The IPL was found to be 3.94 times more effective than the ruby laser for hair removal. In the chin and neck region, more than 3 treatments with the IPL did not improve the therapeutic result significantly.

Laser and photoepilation for unwanted hair growth

BACKGROUND

Unwanted hair growth is a therapeutic challenge and considerable resources are spent to achieve a hair-free appearance. Epilation with laser devices (alexandrite, diode, neodymium:YAG, and ruby lasers) and intense pulsed light are commonly used although the long-term effect is uncertain.

OBJECTIVES

To assess the effects of epilation with lasers and light sources.

SEARCH STRATEGY

We searched the Cochrane Skin Group's Specialised Register in February 2004; MEDLINE (from 1966) and EMBASE (from 1980) in April 2005. We searched reference lists of collected trials and contacted trial authors.

SELECTION CRITERIA

Randomised controlled trials of laser or photoepilation.

DATA COLLECTION AND ANALYSIS

Primary outcomes were objective reduction in hair counts, adverse effects and subjective reduction in hairiness. Secondary outcomes were participants satisfaction and personal observations such as softer, finer, or paler hairs. Two authors independently extracted data and assessed trial quality.

MAIN RESULTS

We included eleven randomised controlled trials involving 444 people, none of which were of high methodological quality. A large number of trials were excluded, mainly because of their non-randomised design. The randomisation procedures were either unclear or inadequate, using coin tossing, alternation, drawing lots or cards, or open tables of random numbers. The interventions and outcomes were too heterogeneous to be entered in a meta-analysis. Most trials examined a short-term effect up to six months after final treatment. There appeared to be a short-term effect of approximately 50% hair reduction with alexandrite and diode lasers up to six months after treatment, whereas little evidence was obtained for an effect of intense pulsed light, neodymium:YAG or ruby lasers. Long-term hair removal was not documented with any treatment. Pain, skin redness, swelling, burned hairs and pigmentary changes were infrequently reported adverse effects.

AUTHORS' CONCLUSIONS

Some treatments lead to temporary short-term hair removal. High quality research is needed on the effect of laser and photoepilation.

The Effect of Varying Pulse Duration, Wavelength, Spot Size, and Fluence on the Response of Previously Treated Capillary Vascular Malformations to Pulsed-Dye Laser Treatment

Modern lasers allow different parameters to be altered in an effort to gain further improvement in otherwise resistant capillary vascular malformations (CMs). The aim of this study was to examine the effect of changing the pulse duration, wavelength, spot size, and fluence on the color and capillary architecture of 585-nm pulsed-dye, laser-resistant CMs. Eighteen patients were assessed with a depth measurement videomicroscope (DMV) before and after 12 test patches with ScleroPlus and V-Beam lasers at specified parameters. In the majority of the test patch areas, there was little improvement after treatment. However, 44% of patients had greater than 75% clearance in at least 1 test patch site. This study demonstrates that both lasers can achieve further lightening in 585 nm 0.45 msec pulsed-dye laser-resistant CMs. However, in CMs consisting of small-diameter deep vessels, further improvement is unlikely.

Evidence-based review of hair removal using lasers and light sources

BACKGROUND

Unwanted hair growth remains a therapeutic challenge and there is a considerable need for an effective and safe treatment modality.

OBJECTIVE

From an evidence-based view to summarize efficacy and adverse effects from hair removal with ruby, alexandrite, diode, and Nd:YAG lasers and intense pulsed light (IPL).

METHODS

Original publications of controlled clinical trials were identified in Medline and the Cochrane Library.

RESULTS

A total of 9 randomized controlled (RCTs) and 21 controlled trials (CTs) were identified. The best available evidence was found for the alexandrite (three RCTs, eight CTs) and diode (three RCTs, four CTs) lasers, followed by the ruby (two RCTs, six CTs) and Nd:YAG (two RCTs, four CTs) lasers, whereas limited evidence was available for IPL sources (one RCT, one CT). Based on the present best available evidence we conclude that (i) epilation with lasers and light sources induces a partial short-term hair reduction up to 6 months postoperatively, (ii) efficacy is improved when repeated treatments are given, (iii) efficacy is superior to conventional treatments (shaving, wax epilation, electrolysis), (iv) evidence exists for a partial long-term hair removal efficacy beyond 6 months postoperatively after repetitive treatments with alexandrite and diode lasers and probably after treatment with ruby and Nd:YAG lasers, whereas evidence is lacking for long-term hair removal after IPL treatment, (v) today there is no evidence for a complete and persistent hair removal efficacy, (vi) the occurrence of postoperative side-effects is reported low for all the laser systems.

CONCLUSION

The evidence from controlled clinical trials favours the use of lasers and light sources for removal of unwanted hair. We recommend that patients are pre-operatively informed of the expected treatment outcome.

Laser hair removal: guidelines for management

Laser-assisted hair removal is the most efficient method of long-term hair removal currently available. Several hair removal systems have been shown to be effective in this setting: ruby laser (694nm), alexandrite laser (755nm), diode laser (800nm), intense pulsed light source (590 to 1200nm) and the neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1064nm), with or without the application of carbon suspension. The parameters used with each laser system vary considerably. All these lasers work on the principle of selective photothermolysis, with the melanin in the hair follicles as the chromophobe. Regardless of the type of laser used multiple treatments are necessary to achieve satisfactory results. Hair clearance, after repeated treatments, of 30 to 50% is generally reported 6 months after the last treatment. Patients with dark colored skin (Fitzpatrick IV and V) can be treated effectively with comparable morbidity to those with lighter colored skin. Although there is no obvious advantage of one laser system over another in terms of treatment outcome (except the Nd:YAG laser, which is found to be less efficacious, but more suited to patients with darker colored skin), laser parameters may be important when choosing the ideal laser for a patient. Adverse effects reported after laser-assisted hair removal include erythema and perifollicular edema, which are common, and crusting and vesiculation of treatment site, hypopigmentation and hyperpigmentation (depending on skin color and other factors). Most complications are generally temporary. The occurrence of hypopigmentation after laser irradiation is thought to be related to the suppression of melanogenesis in the epidermis (which is reversible), rather than the destruction of melanocytes. Methods to reduce the incidence of adverse effects include lightening of the skin and sun avoidance prior to laser treatment, cooling of the skin during treatment, and sun avoidance and protection after treatment. Proper patient selection and tailoring of the fluence used to the patient's skin type remain the most important factors in efficacious and well tolerated laser treatment. While it is generally believed that hair follicles are more responsive to treatment while they are in the growing (anagen) phase, conflicting results have also been reported. There is also no consensus on the most favorable treatment sites.