Clinical comparison of four hair removal lasers and light sources

Adverse Events of Light-Assisted Hair Removal: An Updated Review

BACKGROUND

With light-assisted hair removal becoming widely used, reports of adverse effects are increasing.

OBJECTIVE

To review all the reported optical incidents and cutaneous complications of laser or intense pulse light-assisted hair removal.

METHODS

A PubMed database systematic search was performed to identify studies reporting such adverse events before July 2022 using the Mesh terms "adverse effects" AND "hair removal" AND ("laser" OR "intense pulse light").

RESULTS

Altogether, 358 references were identified. After excluding duplicates, unrelated articles, guidelines, and conference abstracts, then adding references from studies bibliography, 104 publications were included. Ocular incidents consisted of anterior uveitis, iritis and iris atrophy, pupillary distortion, posterior synechiae, anterior chamber pigment, and cataracts in the anterior subcapsular region. Cutaneous complications consisted of pain, burns, folliculitis, leukotrichia, paradoxical hypertrichosis, pigmentary changes, changes in nevi, pili bigemini, herpes infection, hyperhidrosis, bromhidrosis, Fox-Fordyce disease, and frostbite from the cooling system. They were mostly correlated to skin type and body area as well as to light device and set parameters. Intense pulse light devices were found to be less painful than alexandrite laser, yet more painful than diode laser; Nd:YAG laser had the highest pain score.

CONCLUSION

Optical incidents can be systematically avoided. Cutaneous complications are usually related to professional errors and patient characteristics. Better knowledge of laser physics and adequate training of laser operators are key recommendations to avoid undesirable side effects. Safety recommendations help prevent most of the reported complications.

Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria

Introduction

Permanent genital hair removal is required before gender-affirming vaginoplasty to prevent hair-related complications. No previous studies have directly compared the relative efficacy, costs, and patient experiences with laser hair removal (LHR) vs electrolysis treatments. Food and Drug Administration (FDA) oversight of medical devices is poorly understood and commonly misrepresented, adversely affecting patient care.

Aim

This study compares treatment outcomes of electrolysis and LHR for genital hair removal and investigates FDA regulation of electrolysis and LHR devices.

Methods

Penile-inversion vaginoplasty and shallow-depth vaginoplasty patients completed surveys about their preoperative hair removal, including procedure type, number/frequency of sessions, cost, and discomfort. Publicly available FDA-review documents and databases were reviewed.

Main Outcomes Measure

Compared to electrolysis, LHR was associated with greater efficiency, decreased cost, decreased pain, and improved patient satisfaction.

Results

Of 52 total (44 full-depth and 8 shallow-depth) vaginoplasty patients, 22 of 52 underwent electrolysis only, 15 of 52 underwent laser only, and 15 of 52 used both techniques. Compared to patients that underwent LHR only, patients that underwent only electrolysis required a significantly greater number of treatment sessions (mean 24.3 electrolysis vs 8.1 LHR sessions, P < .01) and more frequent sessions (every 2.4 weeks for electrolysis vs 5.3 weeks for LHR, P < .01) to complete treatment (defined as absence of re-growth over 2 months). Electrolysis sessions were significantly longer than LHR sessions (152 minutes vs 26 minutes, P < .01). Total treatment costs for electrolysis ($5,161) were significantly greater than for laser ($981, P < .01). Electrolysis was associated with greater pain and significantly increased need for pretreatment analgesia, which further contributed to higher net costs for treatment with electrolysis vs laser. Many LHR and electrolysis devices have been FDA-cleared for safety, but the FDA does not assess or compare clinical efficacy or efficiency.

Clinical Implications

For patients with dark-pigmented hair, providers should consider LHR as the first-line treatment option for preoperative hair removal before gender-affirming vaginoplasty.

Strength and Limitations

This is the first study to compare electrolysis and LHR for genital hair removal. The discussion addresses FDA review/oversight of devices, which is commonly misrepresented. Limitations include the survey format for data collection.

Conclusion

When compared with electrolysis, LHR showed greater treatment efficiency (shorter and fewer treatment sessions to complete treatment), less pain, greater tolerability, and lower total cost. Our data suggests that, for patients with dark genital hair, providers should consider recommending laser as the first-line treatment for permanent genital hair removal before vaginoplasty.

Yuan N, Feldman A, Chin P, et al. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022;10:100545.

Three wavelengths integrated: Efficacy and safety of a novel combination for hair removal

BACKGROUND

Laser hair removal is one of the most popular aesthetic procedures.

AIMS

The study aimed to assess the efficacy and safety of a novel applicator combining three wavelengths (1064 nm, 810 nm, and 755 nm) for hair removal.

PATIENTS/METHODS

This prospective study included a four-session hair removal treatment with three wavelengths combined and emitted simultaneously using an in-motion technique. Patients were treated in eight-week intervals between each session and a follow-up of 3 months.

RESULTS

Twenty-two men (mean age 41.5 years, SD = 6.1) were included: two (9.1%) Fitzpatrick skin type II, 19 (86.4%) type III, and one (4.5%) type IV. Treated areas were two abdomens (14%), fourteen backs (64%), and five thoraxes (23%). Hair characteristics were evaluated with a dermatoscopic imaging system. Three months after the last session, the mean decrease in the hair count was of 75.6% (SD 5.9) (p < 0.0001), in hair density of 75.6% (SD 5.9) (p < 0.0001), in the terminal hair number of 60.1% (SD 55.0) (p < 0.0001), and in the vellus hair number of 39.7% (SD 72.9) (p = 0.0001).

CONCLUSION

The combined three different wavelengths in a single device provided a wide range of absorption and penetration, allowing for a safe and effective treatment.

Comparison of hair reduction by intensive pulsed light device and combined intense pulsed light with a bipolar radiofrequency

BACKGROUND

Photoepilation has become a very popular epilation procedure in esthetic and cosmetic practice. There are some types of lasers and other light sources used for epilation.

AIMS

The purpose of our study was to compare an IPL device with an IPL plus RF in one device, using a within-patient, right-left controlled study design.

PATIENTS/METHODS

Thirty-three patients completed four treatment sessions and the follow-up period of the study.

RESULTS

Hair reduction was effective after the first treatment, but similar results were achieved using the IPL system alone, and with IPL combined with RF. The degree of hair reduction increased after the following treatments, but the two methods yielded similar effects. Three months after the last treatment, some hair had regrown in both treatments, the combined IPL with RF treatment gave significantly better results than the IPL treatment alone.

CONCLUSIONS

In conclusion, IPL and IPL-RF are effective hair reduction therapies, yielding similar effects in patients with skin phototypes II or III. However, IPL-RF can be more effective in long-term observations. These therapies are also safe and regarded be quite comfortable in this population.

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.

Long-pulsed Nd: YAG Laser and Intense Pulse Light-755 nm for Idiopathic Facial Hirsutism: A Comparative Study

Background:

Hirsutism means excessive terminal hair growth in a female in male pattern distribution. Perception of hirsutism is subjective. Permanent laser hair reduction is a slow process taking many sessions and tracking of improvement parameters is tedious. Hence, a lot of confusion still exists regarding the type of laser most beneficial for treatment.

Aim:

The aim of this study was to compare the effectiveness and safety profile of long-pulsed Nd: YAG laser (1064 nm) and intense pulse light (IPL)-755 nm in management of idiopathic facial hirsutism.

Settings and Design:

Open-labelled, randomly allocated experimental study.

Subjects and Methods:

The study included 33 cases of idiopathic facial hirsutism. Patients were randomly divided into Group A, treated with long-pulsed Nd: YAG laser and Group B, treated with IPL-755 for a total of six sessions at 1 month interval.

Statistical Analysis:

Chi-square test was used in Medcalc^® version 9.0 and the test of significance was taken to be P < 0.05.

Results:

Average percentage of improvement in Group A, according to patients at each sessions were 46.33%, 70.66%, 81.66%, 84.67%, 85.33%, 87.33% and that in Group B were 28.06%, 39.72%, 52.22%, 64.72%, 67.78%, 71.11%, respectively. Excellent response (>75% reduction in hair) after six sessions in Group A was seen in fourteen (93.33%) out of fifteen patients, whereas in Group B, it was seen only in three (16.66%) out of eighteen patients. In Group A, erythema was seen in 26.67%, perifollicular edema and hyperpigmentation in 13.33% each. In Group B, erythema was seen in 50% patients, perifollicular edema in 16.67% and hyperpigmentation in 38.89% patients.

Conclusions:

Long-pulsed Nd: YAG Laser (1064 nm) is better than IPL-755 nm in terms of safety and effectiveness in the management of idiopathic facial hirsutism.

A split-face comparison of facial hair removal with the long-pulsed alexandrite laser and intense pulsed light system

BACKGROUND

Undesirable hair growth presents a significant problem for many patients. Photoepilation has become a very popular procedure in esthetic and cosmetic practice. Among the systems used are the long-pulsed alexandrite laser (755 nm) (ALX) and intense pulsed light (IPL).

OBJECTIVE

To compare the safety and efficacy of long-pulsed ALX and IPL for hair removal.

PATIENTS AND METHODS

This comparative study was carried out in the outpatient Department of Dermatology and Venereology, Al-Sadir Teaching Hospital, Al Najaf City during the period from June 2009 to July 2010. Thirty-five patients were included; thirty of them completed the study. They received six treatment sessions with the ALX on the left side of the face and IPL on the right side of face with 4-week intervals between sessions. Response to treatment on both sides of the face was assessed at 1, 3, and 6 treatment sessions. Hair-free intervals and patient's satisfaction were recorded in each visit.

RESULTS

After six treatment sessions, IPL-treated sides showed longer median hair-free intervals compared with ALX-treated sides. Reduction in hair counts was significantly larger on the IPL compared with that on the ALX-treated sides at 1, 3, and 6 sessions. Three patients (10%) developed postinflammatory hyperpigmentation, one of them on the left side and the others on the right side. It was more severe on the right side and both the patients were of skin type IV. Slight stinging and burning sensation at time of the treatment were recorded in all patients. All reported side effects were transient and tolerated by the patients except postinflammatory hyperpigmentation which persisted and was decreasing gradually toward the end of the study.

CONCLUSIONS

The results of this study suggested that IPL is more effective in reducing excessive facial hair growth, with longer hair-free intervals and greater patient satisfaction than the ALX.

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.

Laser hair removal: a review

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.

Comparison of SHR Mode IPL System with Alexandrite and Nd: YAG Lasers For Leg Hair Reduction

OBJECTIVE

Multiple lasers and light sources are currently available for hair removal and many studies comparing efficacy and safety exist. SHR mode IPL is a technique that gives the total energy in divided doses with fewer side effects. We compared a SHR mode IPL system with alexandrite and Nd: YAG lasers for leg hair reduction.

MATERIAL AND METHODS

Twenty-five female participants with skin types II-IV, underwent treatment of unwanted hair on the cruris. Three selected areas were randomly treated with the SHR mode IPL system, Alexandrite laser and Nd: YAG laser in three sessions. Hair reduction was evaluated with digital photography by a blinded assessor every 6 weeks and 6 months after the last session. Pain severity, side effects and patient satisfaction analysis were also investigated.

RESULTS

Twenty-one participants completed the trial. The mean hair reductions in 6 weeks after the last treatment were 50% for the IPL system, 53% for Alexandrite and 39% for the Nd: YAG lasers. However after 6 months; 40%, 49% and 34% hair reduction was observed, respectively. The Alexandrite laser was the least painful system.

CONCLUSION

Although there is no obvious advantage of one laser system over the others in terms of treatment outcome, the Alexandrite laser is still the most efficient and reliable way of hair removal in fair skinned individuals.

Comparison of hair reduction with three lasers and light sources: prospective, blinded and controlled study

OBJECTIVE

The main goal of this study was to compare the hair removal efficacy of three methods: intense pulsed light (IPL), a combination of IPL and radio frequency (RF) and diode laser (810 nm).

METHODS

Forty participants were treated within three standardized squares on lateral sites on their legs. Each of these squares was treated twice with an interval of 4-6 weeks. The fourth square was left as a control. A blinded physician counted the hairs in each square before the first treatment and 8 months after the second treatment. Immediate and delayed side effects as well as pain scores were recorded.

RESULTS

The mean hair count reduction achieved by the diode laser, IPL and IPL+RF was 49.90%, 39.16% and 47.15%, respectively. This study did not show any serious side effects and the number of side effects was minimal. The mean pain scores for the first and second treatments by diode laser, IPL and IPL+RF were 4.65 and 4.58, 2.43 and 2.53, and 3.95 and 4.03, respectively. At the end of the study, a free hair removal treatment for both legs was chosen by patients in the proportion 20 diode laser, 10 IPL and eight IPL+RF.

CONCLUSIONS

The combination of RF and optical energies proved its safety and efficacy for hair removal, which is comparable with diode lasers and approximately 20% more efficient than 'pure' IPL.

Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities

Background

Epidermal growth factor receptor inhibitors (EGFRI) produce various dermatologic side effects in the majority of patients, and guidelines are crucial for the prevention and treatment of these untoward events. The purpose of this panel was to develop evidence-based recommendations for EGFRI-associated dermatologic toxicities.

Methods

A multinational, interdisciplinary panel of experts in supportive care in cancer reviewed pertinent studies using established criteria in order to develop first-generation recommendations for EGFRI-associated dermatologic toxicities.

Results

Prophylactic and reactive recommendations for papulopustular (acneiform) rash, hair changes, radiation dermatitis, pruritus, mucositis, xerosis/fissures, and paronychia are presented, as well as general dermatologic recommendations when possible.

Conclusion

Prevention and management of EGFRI-related dermatologic toxicities is critical to maintain patients’ health-related quality of life and dose intensity of antineoplastic regimens. More rigorous investigation of these toxicities is warranted to improve preventive and treatment strategies.

Electronic supplementary material

The online version of this article (doi:10.1007/s00520-011-1197-6) contains supplementary material, which is available to authorized users.

Efficacy of intense pulsed light in hirsutism

Unwanted hair growth presents a significant problem for many patients and considerable resources are spent to achieve a hair-free appearance. Our aim of this study was to further evaluate the efficacy of this method in hirsutism in our region. Sixty patients with idiopathic hirsutism presenting to Dermatology Clinics of Tabriz University of Medical Sciences from September 2007 to March 2009 were classified in three groups regarding the site of hirsutism (chine, face, or mustache). All patients underwent IPL-therapy every month for six sessions. The changes in number and diameter of regional hairs were recorded at the end of each session. The patients had the mean age of 25.50+/-3.01 years (18-33 year). The disease was in chin in 26 cases (43.3%), face in 18 patients (30%) and mustache in 16 (26.7%). The skin type was III in 49 (81.7%) or IV in 11 (18.3%) patients. The positive therapeutic response after sixth session in total and in chin, face and mustache were 86.43, 88.66, 86.95 and 82.19%, respectively. The therapeutic response was not statistically significant in different body regions. The hair number in all treated regions was decrease significantly in each session in comparison with the first therapeutic session (p<0.05). Also, the hair diameter at the end of last session was decreased significantly in comparison with the first session in all treated regions (p<0.05). Regarding the high efficacy (86.42%) of IPL in treatment of facial hirsutism and absence of side effect, it is recommended as an effective treatment modality in hirsutism.

Intense pulsed light (IPL): a review

BACKGROUND

Intense pulsed light (IPL) devices use flashlamps and bandpass filters to emit polychromatic incoherent high-intensity pulsed light of determined wavelength spectrum, fluence, and pulse duration. Similar to lasers, the basic principle of IPL devices is a more or less selective thermal damage of the target. The combination of prescribed wavelengths, fluences, pulse durations, and pulse intervals facilitates the treatment of a wide spectrum of skin conditions.

OBJECTIVE

To summarize the physics of IPL, to provide guidance for the practical use of IPL devices, and to discuss the current literature on IPL in the treatment of unwanted hair growth, vascular lesions, pigmented lesions, acne vulgaris, and photodamaged skin and as a light source for PDT and skin rejuvenation.

METHODS

A systematic search of several electronic databases, including Medline and PubMed and the authors experience on intense pulsed light.

RESULTS

Numerous trials show the effectiveness and compatibility of IPL devices.

CONCLUSION

Most comparative trials attest IPLs similar effectiveness to lasers (level of evidence: 2b to 4, depending on the indication). However, large controlled and blinded comparative trials with an extended follow-up period are necessary.

[Photoepilation: state-of-the-art]

The field of dermatological laser medicine consists of four main areas: therapy for blood vessels, therapy for pigmented lesions, ablation of tissue, and photoepilation. The first tests were carried out in 1993, and since 1996 there has been a growing demand for "permanent hair removal." This strong demand and the rapid development of devices call for extensive knowledge in terms of current technical innovation or affirmation of proven procedures. This article gives a general survey of the different systems that can be used for "permanent hair removal" [ruby laser, alexandrite laser, diode, Nd:YAG laser, so-called intense pulsed light (IPL) systems, and combined radio frequency/IPL systems], including their inherent advantages and disadvantages. Physical and biological aspects necessary for photoepilation are pointed out. Furthermore, we emphasize new methods concerning removal of depigmented and therapy-resistant hair, as well as the treatment of female patients with polycystic ovary syndrome.

Nurse-administered laser in dermatology

Nurses have become an essential part of patient care in laser therapy. In dermatology, the potential for helping patients achieve excellent results for individual skin needs is exponential when combined with appropriate technology, evidence-based care, and a competent, conscientious nurse. This article explains how a laser functions, outlines the use of lasers in treating particular dermatologic conditions, provides guidelines for posttreatment care, and discusses the nurse's role in providing laser treatment.