Alexandrite laser hair removal results in 2359 patients: A Turkish experience

Fifteen-minute consultation: Approach to the adolescent presenting with hirsutism

Hirsutism, unwanted terminal hair growth in androgen-dependent areas, is a common presentation to general paediatricians, dermatologists and endocrinologists. Polycystic ovarian syndrome is the most common cause but can be challenging to diagnose in young people due to the significant overlap of features with the healthy adolescent population. There are other rare, but important, causes to consider such as non-classic congenital adrenal hyperplasia and androgen-secreting tumours. Hirsutism carries a significant psychological burden for those living with it. This 15 min consultation piece describes the causes of hirsutism, introduces a novel assessment tool and suggests an approach to investigations and management, including signposting to psychological support.

Depilatory laser miniaturizes hair by inducing bystander dermal papilla cell necrosis through thermal diffusion

OBJECTIVES

Depilatory laser targeting melanin has been widely applied for the treatment of hypertrichosis. Both selective photothermolysis and thermal diffusion have been proposed for its effect, but the exact mechanism of permanent hair reduction remains unclear. In this study, we explore the role of thermal diffusion in depilatory laser-induced permanent hair loss and determine whether nonpigmented cells are injured by thermal diffusion.

MATERIALS AND METHODS

C57BL/6 mice in anagen and telogen were treated with alexandrite laser (wavelength 755 nm, pulse duration 3 milliseconds, fluence 12 J/cm² , spot size 12 mm), respectively. Histological analysis, terminal deoxynucleotidyl transferase dUTP nick-end labeling assay, and transmission electron microscopic imaging were employed to evaluate the injury to hair follicle (HF) cells. The proliferation status of HF cells was examined by 5-bromo-2'-deoxyuridine pulse labeling. The number of HF stem cells was quantified by fluorescence-activated cell sorting. The size of the regenerated hair was determined by measuring its length and width.

RESULTS

We found that irradiating C57BL/6 mice in anagen with alexandrite laser led to hair miniaturization in the next anagen. In addition to thermal disruption of melanin-containing cells in the precortex region, we also detected necrosis of the adjacent nonpigmented dermal papilla cells due to thermal diffusion. Dermal papilla cells decreased by 24% after laser injury, while the number of bulge stem cells remained unchanged. When the laser was delivered to telogen HFs where no melanin was present adjacent to the dermal papilla, thermal necrosis and cell reduction were not detected in the dermal papilla and no hair miniaturization was observed.

CONCLUSION

Our results suggest that depilatory laser miniaturizes hair by inducing thermal necrosis of dermal papilla cells due to secondary thermal diffusion from melanin-containing precortex cells in the anagen hair bulbs.

Paradoxical Hypertrichosis Associated with Laser and Light Therapy for Hair Removal: A Systematic Review and Meta-analysis

BACKGROUND

Paradoxical hypertrichosis (PH) is an uncommon, poorly understood adverse effect associated with laser or intense pulsed light treatment for hair removal.

OBJECTIVE

The objective of this study was to conduct a systematic review and meta-analysis to determine PH prevalence and associated risk factors.

METHODS

We conducted a systematic review and meta-analysis of studies evaluating hair removal with lasers or intense pulsed light. Primary outcome was PH prevalence. Meta-regression and subgroup analysis were used to investigate associations among treatment modality, patients' characteristics, and PH.

RESULTS

Included were 9733 patients in two randomized controlled trials and 20 cohort studies (three prospective and 17 retrospective). Pooled PH prevalence was 3% (95% confidence interval 1-6; I² = 97%). Paradoxical hypertrichosis was associated with a face or neck anatomic location, and occurred in only 0.08% of non-facial/neck cases. Treatment modality and interval between treatments had no effect on the PH rate. There were insufficient data to determine the association between sex and skin type to PH. In three out of four studies, PH gradually improved with continued therapy.

CONCLUSIONS

Based primarily on cohort studies, PH occurs in 3% of patients undergoing hair removal with lasers or intense pulsed light, yet rarely outside the facial/neck areas. Treatment modality does not seem to be a contributing factor. Continuation of treatment in areas with PH may be the most appropriate treatment.

Reconceptualizing the permanence of alexandrite laser hair removal results: a long-term follow-up study

Background: The permanence of Alexandrite laser hair removal (LHR) has been of great interest. However, studies on long-term outcome are lacking.Objective: To evaluate the hair reduction rates (HRRs) and laser parameters of patients who no longer need epilation after LHR, and redefine permanence.Patients & Methods: Out of 183, 100 patients who discontinue epilation at least 2 years after LHR were included in the study. Self-perceived HRRs and patient satisfaction were recorded through patient questionnaires. The correlations between HRRs and treatment parameters, and the presence of polycystic ovary syndrome (PCOS) were assessed.Results: Treatment sites were the face, legs, trunk, arm and bikini regions. Twenty-one patients had PCOS. The means of results (in range) were as follows; HRRs [56.28% (±19.73) and 67.74% (±16.42)]; the session numbers [5.52 (±2.50) and 9.80 (±4.15)] and, the treatment durations [62.2 (±40.0) and 90.0 (±45.9) weeks]. All patients stated they no longer require epilation since the remaining hairs were too thin to be noticed.Conclusion: Our results demonstrate that, even in the presence of PCOS, hair reduction together with thinning satisfy patients without total removal of hairs. Therefore, the elimination of the need for epilation might be considered as the 'permanent result' of LHR.

Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline

OBJECTIVE

To update the "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2008.

PARTICIPANTS

The participants include an Endocrine Society-appointed task force of seven medical experts and a methodologist.

EVIDENCE

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.

CONSENSUS PROCESS

Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.

CONCLUSION

We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen-progestin contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For most women who choose hair removal therapy, we suggest laser/photoepilation.

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.

Effects of hair removal alexandrite laser on biometric parameters of the skin

The effects of alexandrite laser (AL) on skin parameters such as melanin content, skin layer depth, elasticity, and density have not been investigated through biometric methods. We aim to assess the effect of AL on the skin parameters through biometric devices to determine whether it has positive effects on treated region. In this pretest-posttest study, we recruited patients who attended Laser Clinic of Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran, from January through December 2014. Patients had to be free of any dermatologic conditions and lesion at the site of treatment or any contraindication to laser therapy. Baseline measurements were performed and patients received four sessions of AL therapy (spot size, 12 mm; fluence, 12 J/cm(2); and pulse width, 5 Hz) with 4-week intervals. Four weeks after the last treatment session, the same parameters were assessed that included skin color, transepidermal water loss (TEWL), dermis and epidermis density and depth (through skin ultrasonography), melanin content, erythema intensity, and skin elasticity. Biometric parameters of 33 patients (27 females [81.8%]), with mean (SD) age of 35.7 (9.5) years were evaluated. The mean percent changes of skin parameters were as follows: skin color, 5.88% through Visioface and by 56.8% through Colorimeter devices (became lighter); melanin content, -15.95%; TEWL, -2.96%; elasticity, +14.88%; dermis depth -19.01%; and dermis density, +1580.11% (P < 0.001 for changes in each parameter). AL could decrease melanin content of the skin and make the skin thinner while it could increase elasticity and density of epidermis and dermis, which might indicate increased collagen content of skin.