Laser hair removal: a review

Laser and Light-Based Therapies for Hirsutism Management in Women With Polycystic Ovarian Syndrome: A Systematic Review

Importance

Hirsutism represents a significant concern for women with polycystic ovary syndrome (PCOS), with deleterious psychological effects warranting acknowledgment and a clear imperative to provide effective management. To our knowledge, this is the first review to exclusively examine the effectiveness of laser and light-based therapies in addressing hirsutism in women with PCOS.

Objective

To synthesize the existing literature regarding the effectiveness of laser and light hair reduction therapies, either as stand-alone treatments or in combination with systemic agents, in treating hirsutism for women with PCOS.

Evidence Review

A systematic literature review was performed using MEDLINE, Embase, EMCARE, and CINAHL according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Articles written in English, reporting on patients who met pre-established inclusion criteria were selected. Objective and subjectively measured outcomes relating to the effect of laser or light-based hair reduction therapies on hirsutism were abstracted. Heterogeneity among included studies precluded a meta-analysis, necessitating a narrative synthesis.

Findings

Six studies reporting data on 423 individual patients with PCOS who underwent laser or light-based hair reduction therapies were included: 4 randomized clinical trials and 2 cohort studies. Alexandrite laser demonstrated significant improvements in hirsutism severity and psychological outcomes, particularly at high-fluence application. Alexandrite laser was also found to be more effective than intense pulsed light (IPL). The combination of diode laser with either metformin or combined oral contraceptive pill was superior to the application of diode laser alone, just as the addition of metformin to IPL demonstrated superior results to IPL treatment alone. Overall, most interventions were well tolerated. The overall certainty of evidence across all outcomes and comparisons was limited in part due to the observational nature of some studies.

Conclusions and Relevance

This systematic review highlights the potential of laser and light hair reduction therapies, both as stand-alone treatments and in combination with other pharmacological agents in PCOS. However, this review was limited by low certainty of the evidence, few studies evaluating effectiveness and safety in those with skin of color, and heterogeneity in outcome assessment. Future studies are needed to provide more robust evidence among diverse individuals with PCOS and hirsutism.

Safety of using laser for hair removal in patients with skin diseases: a retrospective study

Laser hair removal is a commonly used method in dermatology which is based on selective thermolysis and utilizes the appropriate wavelength, pulse width, and energy density to damage hair follicles. Given the prevalence of skin diseases such as psoriasis, dermatitis, and vitiligo, and the increasing popularity of laser hair removal, the aim of this study was to investigate the safety of laser hair removal in individuals with skin diseases. This retrospective study was conducted at the laser department of Razi Hospital on 99 patients who underwent laser hair removal. The exacerbation of disease after laser therapy was significantly associated with active skin disease (p = .021) and laser treatment at the site of the disease (p < .001). The incidence of Koebner phenomenon was significantly associated with age (p = .017) and the number of sessions with the ND-YAG device (p = .034). It is crucial to exercise caution when performing laser treatment on individuals with active skin disease and to avoid treating the affected area were possible. If necessary, it is recommended to delay laser treatment until the disease is under control for patients with active skin disease or those who wish to receive laser treatment at the site of the disease.

Complications of dermatologic lasers in high Fitzpatrick phototypes and management: an updated narrative review

This article explores the intricacies of laser surgery, acknowledging inherent risks and complications. Patients with higher Fitzpatrick phototypes, characterized by unique biological traits, face heightened vulnerability during laser treatments. Limited experience with darker skin tones necessitates a higher level of laser expertise and a conservative approach. The study aims to comprehensively review laser therapy's side effects and complications, with a specific focus on Fitzpatrick phototypes IV through VI. We searched the MEDLINE database from 1972 to 2023 to consolidate knowledge. Results illuminate nuanced challenges associated with laser surgery in higher phototypes. In conclusion, this research emphasizes the need for enhanced expertise and caution in laser procedures for individuals with darker skin, offering valuable insights to optimize patient safety and outcomes.

Angiokeratoma of Fordyce-A rare complication of laser hair removal: A case report of two patients

Key Clinical Message

This study highlights the first documented cases of angiokeratoma of Fordyce following laser hair removal (LHR) emphasizing the importance of patient selection and careful laser use. It underscores the importance of understanding LHR-associated risks, particularly for patients with darker skin. The efficacy of topical rapamycin as an alternative treatment for angiokeratomas is also discussed.

Abstract

Laser hair removal (LHR) has emerged as a widely accepted method for achieving long-term hair reduction. While generally considered safe, it is important to study the possible adverse events to optimize patient care. Here, we present a unique case report of angiokeratoma of Fordyce, a rare vascular lesion, following LHR. Two patients experienced the development of these lesions subsequent to LHR treatment sessions, characterized by a severe burning sensation during the procedure. Interestingly, both individuals exhibited varicose veins on their legs, suggesting a potential risk factor for this complication. Our findings highlight the importance of understanding the mechanisms underlying LHR-induced adverse events and the need for further research to elucidate associated risk factors and management strategies. This case report serves to enhance awareness among clinicians and emphasizes the significance of patient counseling regarding the potential side effects of LHR.

Barriers to Completing Preoperative Hair Removal for Penile Inversion Vaginoplasty

Penile inversion vaginoplasty (PIV) is a gender-affirming surgical procedure where the skin of the penis and scrotum is reconstructed into the neovaginal lining. To prevent hair-bearing skin from becoming incorporated into the neovaginal canal, transgender patients are encouraged to undergo hair removal of their external genitalia. The goal of this preoperative hair removal is to minimize the risk of potential hair-related complications after vaginoplasty. To better support patients seeking preoperative hair removal and identify current treatment barriers, we surveyed patients about their progress and satisfaction with hair removal. A cross-sectional survey was constructed to assess patient experiences with hair removal in advance of PIV. Sixty-seven patients met the inclusion criteria, of which 46 participated (68.7%). Both laser hair removal (LHR) and electrolysis were used. Although all patients had completed some preoperative hair removal at the time of survey (average of 14 sessions), the cohort completed only two-thirds of their total expected hair clearance. Multiple peri-procedural pain management therapies were employed, but overall satisfaction with pain management was low (57.4 ± 5.0 out of 100). LHR was associated with significantly lower procedural pain compared to electrolysis (p < .001). The average global satisfaction with the hair removal process was 57.9 ± 5.7 and incidents of mistreatment were associated with a statistically significant reduction in overall satisfaction (p = .02). Most patients felt that hair removal was important prior to surgery. Overall, LHR and electrolysis were both utilized as effective preoperative hair removal modalities; however, LHR has better pain tolerability than electrolysis.

A review of hair removal modalities in pediatric patients: Ethical and clinical considerations

Unwanted hair is a common concern among patients presenting to pediatric dermatology clinics, and parents and patients alike inquire about the safety of methods employed for elective removal. Various methods of hair removal exist with different levels of invasiveness and permanence, from simple mechanical depilation to light-based therapies. All methods of hair removal appear to be safe and generally well tolerated in children, and there are no age restrictions to any modality. In this review, we aim to address the available literature on the safety and efficacy of hair removal modalities in pediatric patients and propose guidance on how to manage requests for at-home and in-office therapies within an ethical framework.

Using "Appointment Tickets" to Track Visit Duration as a Quality Improvement Initiative After Incorporating Laser Epilation in a Pilonidal Care Clinic

BACKGROUND

Laser epilation (LE) is effective in decreasing pilonidal disease (PD) recurrence, but laser use has not been a standard practice in pediatric surgery clinic. We hypothesized that "appointment tickets" can 1) track utilization and clinic visit delays, 2) inform patients of their clinic progress in real time.

METHODS

An observation study was performed on LE patients treated at our PD clinic 3/2021-7/2022. Two exam rooms were utilized for manual shaving and one for LE. After gluteal cleft hair shaving, various anesthetic (topical lidocaine, ice, or cryotherapy) was applied prior/during LE. At each visit, patient received an "appointment ticket" on which providers recorded the visit start/end time, manual shaving duration, local anesthetic application/wait time, LE duration. Visits were scheduled for 20 min-slots. Clinic staff recorded any delays (>20 min).

RESULTS

1317 visits were recorded. Mean number of visits per week was 18 ± 6. Mean total visit length was 60 ± 22 min, mean shaving time 15 ± 11 min, mean anesthetic application/wait time 16 ± 11 min, mean LE time 14 ± 9 min. Over the study period, average visit length has decreased, and average visits/clinic day has increased. Most delays occurred in months April, May, October-December. Delays due to patient late arrival occurred in May, July, and August of 2021, none in 2022.

CONCLUSIONS

LE visits have multiple components that required close coordination to ensure no clinic delays. Clinic delays spiked prior to summer and winter holidays. "Appointment tickets" provided patients with real-time visit progress tracked clinic utilization to improve the quality of pilonidal care delivery.

LEVEL OF EVIDENCE

Level IV.

Trunk hair removal treatment with diode laser 810 nm in men population

In the last years, hair removal has been one of the most common treatments performed for aesthetic purposes, especially in women. Nevertheless, even if it is less popular, the demand within men population has risen. The study aimed to assess the acceptability of the diode 810 nm treatment for hair removal on the back and chest area in men thanks to the speed of treatment and the absence of undesirable effects. For this study, 20 patients were treated for hair removal. They were men with a mean age of 30.5 (±7.3). They underwent 4 treatment sessions at 40-day intervals on the trunk (chest and back area). Patients ranged between a Fitzpatrick phototype I (20%, 4/20) to IV (15%, 3/20) (40% were type II and 25% type III). Moreover, patients were asked to report pain intensity sensation with a visual analogue scale. Overall, in the study population, a hair reduction of 80.6% (±2.8) was registered in the treated areas. The device described in this study was demonstrated to be highly efficient in extended body areas and on difficult-to-treat hair follicles like on the back and chest in the men population.

Laser Hair Removal for Intraoral Flaps: A Review

Importance: Laser hair removal is a noninvasive technique that has been used for patients with oropharyngolaryngeal hair growth related to surgical flap reconstruction after head and neck cancer resection. The purpose of this work was to perform a rapid review of the literature to determine the therapeutic relevance of laser hair removal and identify laser parameters. Observations: A total of 10 publications addressing depilation of the head and neck sphere were selected and analyzed. Conclusions and Relevance: Laser therapy appears to be a promising treatment for hair removal from flaps with few side effects. However, there is no scientific basis for a standardized protocol or determination of the superiority of laser hair removal over another treatment.

Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial

Importance

Recurrence continues to be a significant challenge in the treatment and management of pilonidal disease.

Objective

To compare the effectiveness of laser epilation (LE) as an adjunct to standard care vs standard care alone in preventing recurrence of pilonidal disease in adolescents and young adults.

Design, Setting, and Participants

This was a single-institution, randomized clinical trial with 1-year follow-up conducted from September 2017 to September 2022. Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital.

Intervention

LE and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone.

Main Outcomes and Measures

The primary outcome was the rate of recurrence of pilonidal disease at 1 year. Secondary outcomes assessed during the 1-year follow-up included disability days, health-related quality of life (HRQOL), health care satisfaction, disease-related attitudes and perceived stigma, and rates of procedures, surgical excisions, and postoperative complications.

Results

A total of 302 participants (median [IQR] age, 17 [15-18] years; 157 male [56.1%]) with pilonidal disease were enrolled; 151 participants were randomly assigned to each intervention group. One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group. The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (-23.2%; 95% CI, -33.2 to -13.1; P < .001). Over 1 year, there were no differences between groups in either patient or caregiver disability days, or patient- or caregiver-reported HRQOL, health care satisfaction, or perceived stigma at any time point. The LE group had significantly higher Child Attitude Toward Illness Scores (CATIS) at 6 months (median [IQR], 3.8 [3.4-4.2] vs 3.6 [3.2-4.1]; P = .01). There were no differences between groups in disease-related health care utilization, disease-related procedures, or postoperative complications.

Conclusions and Relevance

LE as an adjunct to standard care significantly reduced 1-year recurrence rates of pilonidal disease compared with standard care alone. These results provide further evidence that LE is safe and well tolerated in patients with pilonidal disease. LE should be considered a standard treatment modality for patients with pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients.

Trial Registration

ClinicalTrials.gov Identifier: NCT03276065.

Efficacy and safety of diode laser for facial hair reduction in hirsutism-a clinico-trichoscopic evaluation

Background

Hirsutism is the presence of excessive terminal hair on androgen-dependent sites of the body. Lasers like Alexandrite, diode, and Nd:Yag lasers have been used for hair reduction with varying efficacy. Trichoscopy of hair is a simple noninvasive method of hair assessment. However, it has not been used in the assessment of diode laser hair reduction.

Objectives

This study aimed to assess the efficacy and safety of diode laser hair reduction in skin color with the help of clinical and trichoscopic assessment.

Materials and Methods

This prospective observational study included 73 patients of hirsutism recruited in 18-month period. All participants received sessions of 805 nm diode laser at monthly intervals up to six sessions. Clinical and trichoscopic evaluation along with photographs were obtained at each visit. Side effects, if any, were noted in every sitting.

Results

All patients were females of Fitzpatrick skin types III-V. All clinical parameters showed statistically significant hair reduction when compared with baseline. Trichoscopic parameters of hair reduction like total hair count, terminal hair count, and terminal/vellus hair ratio showed reduction compared to baseline which was statistically significant (P < 0.05). The most common side effect noted in our study was pain followed by erythema and perifollicular edema.

Conclusions

Diode laser is an effective and safe procedure for the reduction of unwanted facial hair, even in darker skin types. We also wish to emphasize that trichoscopy for the assessment of laser hair reduction is a recent, noninvasive, simple, and underutilized tool. No serious adverse events were noted in our study.

Hair follicle extraction combined with an expanded scalp flap for facial organ reconstruction

BACKGROUND

Use of scalp skin for facial organ reconstruction represents a mainstream procedure for organ reconstruction. In most cases, adequate amounts of skin can be obtained by using tissue expanders, but harvesting sufficient scalp tissue in patients with low hairlines is challenging. Hair follicular unit extraction (FUE) is one approach to resolve this problem. With FUE, hair follicles are removed from the scalp skin, which can then be prepared as a donor site to obtain sufficient amounts of hairless skin.

OBJECTIVES

To evaluate the safety and efficacy of FUE when combined with an expanded scalp flap for facial organ reconstruction.

MATERIAL AND METHODS

Patients with low hairlines requiring facial organ reconstruction were selected for this study. The area of skin extension and hair removal were determined prior to surgery, a process which was performed in three stages. Stage I consisted of hair follicle removal using the FUE technique at the donor site. Stage II involved expander implantation using water injections. In Stage III facial organ reconstruction was completed.

RESULTS

With the use of the FUE technique, hair follicles from the donor scalp were thoroughly removed and the donor scalp tissue was successfully expanded. Postoperatively, no evident scar formation at the reconstruction site or contracture of the expanded flap was observed. All patients were satisfied with the outcome of their reconstruction procedure.

CONCLUSION

FUE provides a means for hair follicle removal from the donor site and can be employed to achieve a safe and effective procedure for facial reconstruction in patients with low hairlines.

Effects at cellular level of epilation with various laser wavelengths applied simultaneously on different skins: two case reports

This study evaluated the effects of laser application of diverse wavelengths applied simultaneously and on different skins. The sample included two participants, a woman with light skin with abdominal hair and a woman with dark skin and hair on the inner part of the lower limbs, who received a laser therapy session. After 45 days from laser application, abdominoplasty and thigh dermolipectomy surgery were performed. In the control sample, the hair follicles were in the anagen phase, showing the presence of Bcl-2 expression. In the treated areas, follicles were observed in an advanced phase (telogen), with the presence of CK-18 and negativity of Bcl-2, highlighting the phase of hair loss at that moment and the complete apoptosis of the investigated follicle. Significant difference was observed in the comparison of the anagen phase (p = .00) and it similarly occurred in the comparison of the telogen phase (p = .00). The presence of a greater amount of follicles in the anagen phase in the control area and follicles in the telogen phase in the treated area demonstrates the efficiency of the laser at different wavelengths when reaching different skin phototypes and hair thickness, being reinforced by apoptosis and cell proliferation markers. Therefore, the hair-removal process has been optimized with various laser wavelengths.

Optimal Timing of Laser Hair Removal in Expanded Forehead Flap in the Reconstruction of Facial Defects: During or After Tissue Expansion?

Background: The optimal timing of laser epilation with expanded forehead flaps in facial defect reconstruction remains undetermined. Objective: To compare the efficacy and safety of hair removal during or after flap expansion. Methods: This prospective exploratory study included 15 (11 women and 4 men, 16.47 ± 16.331 years of age) and 26 (19 women and 7 men, 10.69 ± 10.899 years of age) patients who underwent 755 nm long-pulsed alexandrite laser epilation during flap expansion and after surgery, respectively. Facial reconstruction was performed in these patients because of congenital melanin nevus, scar or port-wine stains. Evaluation included hair reduction rate, patient satisfaction, and adverse events. Results: The median number of laser sessions for hair removal during flap expansion was significantly lower than that after surgery (2.00 vs. 3.00, p < 0.01), and the hair reduction rate was also significantly higher during flap expansion (79.5% ± 21.93% vs. 68.3% ± 17.44%, p < 0.05). No severe adverse events were reported. Conclusion: Laser hair removal is safe and efficient when performed both during flap expansion period and after surgery, but its efficacy was significantly higher, and fewer sessions were required when performed during tissue expansion. Clinical trial registration information: ChiCTR1900026090.

X-ray generation by fs-laser processing of biological material

The use of ultrashort pulse lasers in medical treatments is increasing and is already an essential tool, particularly in the treatment of eyes, bones and skin. One of the main advantages of laser treatment is that it is fast and minimally invasive. Due to the interaction of ultrashort laser pulses with matter, X-rays can be generated during the laser ablation process. This is important not only for the safety of the patient, but also for the practitioner to ensure that the legally permissible dose is not exceeded. Although our results do not raise safety concerns for existing clinical applications, they might impact future developments at higher peak powers. In order to provide guidance to laser users in the medical field, this paper examines the X-ray emission spectra and dose of several biological materials and describes their dependence on the laser pulse energy.

Expert opinion about laser and intense pulsed light (IPL)-induced leukoderma or vitiligo: a cross-sectional survey study

Vitiligo patients may desire laser hair removal, skin rejuvenation, vascular treatments, and other laser or intense pulsed light (IPL) assisted treatments. However, there is a risk of inducing new depigmented patches (Koebner phenomenon). In absence of guidelines on the safe use of laser or IPL in vitiligo patients, dermatologists tend to be reluctant to administer these treatments. The aim of this survey study was to provide an estimation of the occurrence and related risk factors of laser/IPL-induced leukoderma or vitiligo. A cross-sectional survey study was performed among 15 vitiligo experts from 11 countries, with 14 questions about affected patients, involved laser/IPL treatments and the physicians' approach. In a total of 11,300 vitiligo patients, laser/IPL-induced leukoderma or vitiligo was reported in 30 patients (0.27%). Of these, 12 (40%) patients had a medical history of vitiligo and seven (58%) of these patients had stable (> 12 months) vitiligo before the treatment. Most frequently reported were hair removal procedures and localization of the face and legs. Side effects like blistering, crusting, and erosions occurred in 56.7% of the cases. These vitiligo experts based their advice on the risk of the laser treatment on stability of the vitiligo (43%) and activity signs (50%), and 50% discuss the risks before starting a laser treatment. Relevant activity signs are the Koebner phenomenon (57.1%), confetti-like lesions (57.1%) and hypochromic borders (50%). Laser-induced leukoderma or vitiligo is an uncommon phenomenon. Remarkably, a minority had a medical history of vitiligo of which 58% were stable. Consequently, most cases could not have been prevented by not treating vitiligo patients. However, a majority had laser/IPL-induced skin damage. Therefore, caution is advised with aggressive settings and test-spots prior to the treatment are recommended. This study showed significant variation in the current recommendations and approach of vitiligo experts regarding laser/IPL-induced leukoderma or vitiligo.

Severe Burns of the Genital Area After Laser Hair Removal: A Case Report

Burn injuries are among the most commonly observed complications of laser hair removal. Here, we present a case, in which severe massive burns were caused in the genital and perineal areas during such a procedure. The consequent scar formation led not only to negative aesthetic effects but also affected the physical and psychological health of the patient.

Awareness and knowledge of laser hair removal: a cross sectional study from tertiary care dermatology clinics in Oman

BACKGROUND

Laser hair removal (LHR), including the use of home-based devices, is becoming very popular in Oman. Despite this, some people still have many misconceptions about this procedure, especially of its long-term complications. This study aimed to assess the awareness and knowledge of LHR among dermatology clinic attendees in Muscat, Oman.

METHODS

A cross sectional survey study was conducted at Al Seeb and Bowshar polyclinics in Muscat, Oman, to attendees between the ages of 18 and 70 years. The Chi-square test was used to assess the association between different categorical variables. Results were considered to be statistically significant if P < 0.05.

RESULTS

Of the 500 questionnaires which were distributed, 403 were completed (response rate = 80.6%). The mean (± standard deviation [SD]) age of participants was 32.9 (8.5) years old. In this study, 45.7% (184/403) of participants had used LHR, and of those, 88.6% (163/184) were satisfied with the results. The knowledge percentage among individuals was higher among those who used LHR compared to those who did not use LHR (46% vs. 27%, respectively; P < 0.001). However, there were no significant differences in LHR knowledge percentages based on employment status or monthly income. Female participants and subjects with an educational level of a college degree or above had superior knowledge regarding the safety of LHR use during pregnancy (P < 0.05).

CONCLUSIONS

This study noted a lack of knowledge, with various misconceptions, about LHR among patients attending dermatology clinics in Oman, especially in individuals who had not used LHR before.

Changes in melanocytic nevi treated with laser hair removal: A systematic review

BACKGROUND

Incidental treatment of melanocytic nevi during laser hair removal (LHR) has been noted to cause clinical and dermoscopic changes that may appear similar to findings seen in atypical or neoplastic melanocytic lesions. The rate and characteristics of these changes has not been well-studied.

OBJECTIVES

The objective of this review article is to assess the literature for reported changes in melanocytic nevi following LHR to guide clinical practice.

METHODS

PubMed was searched December 5, 2022 for articles evaluating changes in melanocytic nevi after LHR treatment using the following search terms: "nevi laser hair removal," "nevi diode," "nevi long pulse alexandrite," "nevi long pulse neodymium doped yttrium aluminum garnet," and "melanoma laser hair removal." All English language patient-based reports discussing incidental treatment of melanocytic nevi while undergoing LHR with a laser were eligible for inclusion, while reports of changes following hair removal with non-laser devices such as intense pulsed light were excluded. Studies evaluating non-melanocytic nevi such as Becker's nevus or nevus of Ota were excluded as were those evaluating the intentional ablation or removal of melanocytic lesions.

RESULTS

Ten relevant studies were included, consisting of seven case reports or series and three observational trials, two of which were prospective and one retrospective. Among the seven case reports or series there were a total of 11 patients, six of which had multiple affected nevi. Clinical and dermoscopic changes to nevi following LHR appear to be common in clinical practice, though not well studied. Clinical and dermoscopic changes have been noted to present as early as 15 days after treatment and persist to the maximum time of follow up at 3 years. Commonly reported changes include regression, decreased size, laser induced asymmetry, bleaching, darkening, and altered pattern on dermoscopy. Histologic changes include mild atypia, thermal damage, scar formation, and regression. Although some of the clinical and dermoscopic alterations may be concerning for malignancy, to our knowledge, there are no documented cases of malignant transformation of nevi following treatment with LHR.

LIMITATIONS

This study is limited by the low number of relevant reports and their generally small sample size, many of which is limited to single cases. Additionally, comparison of available data was limited by variable reporting of treatment regimens and outcomes.

CONCLUSIONS

Changes to nevi treated during LHR are not uncommon. Modifications to nevi may occur and look similar to changes seen in dysplastic or neoplastic melanocytic lesions. Notably, despite the widespread use of LHR since the first device was Food and Drug Administration approved in 1995, a time span of nearly three decades, there have been no reported cases of melanoma or severe dysplastic changes within treated nevi. However, dermatologists should be aware that morphologic and dermoscopic alterations can occur after LHR to prevent unnecessary surgical procedures. Although melanoma has not been reported to occur in nevi treated with LHR nor with any other laser exposures, further long-term data is needed to fully elucidate this concern. Optimally, nevi should be examined by a dermatologist before LHR to determine a baseline clinical and dermoscopic morphology. If there is concern for potential atypia, laser should be avoided over such nevi to avoid confusion at future follow up visits.

Management of Pilonidal Disease: A Review

Importance

The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity.

Observations

There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies.

Conclusions and Relevance

Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.

Laser and light therapy for pediatric hair removal: a systematic review

Hair removal with lasers and intense pulsed light (IPL) is considered safe. However, data on the efficacy and safety of these procedures specifically in the pediatric population remain sparse. To determine the efficacy and safety of lasers and IPL for hair reduction in children and adolescents, a systematic review was conducted of original studies evaluating hair removal with lasers or IPL in patients aged less than 18 years. Primary outcome measures were efficacy and safety of treatment. The literature review yielded 2 retrospective cohort studies and 11 case reports/case series including a total of 71 patients aged 9 months to 17 years. Diagnoses ranged from localized lumbosacral to generalized hypertrichosis. Six treatment modalities were evaluated: alexandrite, Nd:YAG, Q-switched Nd:YAG, ruby, and diode lasers and IPL. Only one of the cohort studies (n = 28), using the ruby laser, provided efficacy data. The results showed a 63% hair loss in 89% of patients after completion of treatment, although partial regrowth was evident during 6 to 32 weeks of follow-up. Most of the case reports and case series (10/11) reported significant hair reduction following laser and IPL treatments. None of the patients experienced scarring or dyspigmentation. Some kind of pain management was necessary in 65% of patients; 25% required general anesthesia. On the basis of the limited available data which consisted primary of case reports and case series, lasers and IPL might be effective for pediatric hair reduction. Recurrence following treatment may be higher in children than adults, and pain control may be a limiting factor.

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.

Efficacy of Laser in Hair Removal: A Network Meta-analysis

BACKGROUND

Laser hair removal is an increasingly prevalent trend of cosmetic procedures. The purpose of this study was to assess the effectiveness of hair reduction among several types of laser interventions.

METHODS

The selected studies searched in PubMed and EMBASE were assessed for quality of evidence, and extracted data on absolute hair count and hair reduction rate. Qualitative data were synthesized using standardized mean difference (SMD) in frequentist network meta-analysis because various measurement units were used among selected studies. Inconsistency and small study effects were examined by design-by-treatment interaction model and comparison-adjusted funnel plot.

RESULTS

A total of 13 randomized controlled trials (RCTs) (n = 652) were contributed to network meta-analysis. Pooled results revealed that diode laser showed significantly lower absolute hair count within three-month (SMD = -13.21, 95% confidence interval [CI]: -22.25 to -4.17) and around six months follow-up (SMD = -11.01, 95% CI: -18.24 to -3.77) as compared with those in control group, but no significant difference among laser interventions. All side effects observed were transient without leaving any permanent scars.

CONCLUSION

Eliminating unwanted hair with lasers or intense pulsed light is safe and effective; however, which type of intervention is more beneficial in the long-term process should be studied with a longer follow-up time.

Comparing Traditional and “In-Motion” Intense Pulsed Light Techniques for Hair Removal: A Split Study

Background and Objectives: Hair removal is a common aesthetic concern for patients referred to dermatologists and aesthetic physicians. Lasers and lights are one of the mainstays in the management of this condition. Among these devices, intense pulsed lights (IPLs) are broadly used in order to reduce the number and width of the hair present. Currently used techniques are associated with a high risk of side effects, such as hyper or hypopigmentation. Materials and Methods: Thirty patients seeking hair removal in one or more body areas with skin phototypes 1 to 4 were recruited to perform this study. All areas to be treated were divided into two equal regions; one side was treated with the standard IPL hair removal procedure, while the other was treated with a new “in-motion” IPL technology. Results and hair removal rates were evaluated six months after the last treatment. Results: Out of the 30 patients treated, all patients experienced hair reduction. No statistically significant difference in hair removal was noted among the two sides. A statistically significant reduction in pain during the procedure was observed in the side treated with the “in-motion” technique. Conclusions: Traditional and “in-motion” IPL techniques have similar results in hair removal; the “in-motion” technology seems to guarantee a better safety profile than the traditional technique, as well as maintains the same results over time and a faster treatment time. A more extensive clinical study will be necessary to confirm our study’s results.

Assessment of adverse events for a home-use intense pulsed light hair removal device using postmarketing surveillance

BACKGROUND AND OBJECTIVES

Home-use intense pulsed light (IPL) hair removal devices are convenient for consumers. Consumer safety associated with home-use IPL devices, however, remains a subject of interest. In this descriptive analysis, we assessed the most commonly reported adverse events (AEs) for a home-use IPL device from postmarketing surveillance and qualitatively compared these with AEs from clinical studies and medical device reports of home-use IPL treatments.

MATERIALS AND METHODS

For this analysis of voluntary reports, we queried a distributor's postmarketing database for IPL devices for the period beginning January 1, 2016, to December 31, 2021. All sources of comments, for example, phone, e-mail, company-sponsored web sites, were included in the analysis. AE data were coded according to the Medical Dictionary for Regulatory Activities (MedDRA) terminology. Also, we conducted a PubMed search to identify AE profiles from existing literature on home-use IPL devices and we searched the Manufacturer and User Facility Device Experience (MAUDE) database for reports on home-use IPL devices. These results were qualitatively compared to the data in the postmarketing surveillance database.

RESULTS

A total of 1692 cases involving IPL were identified from voluntary reports of AEs between 2016 and 2021. The shipment-adjusted reporting rate for AE cases (number of AE cases/100,000 shipped IPL devices) was 67/100,000 during this 6-year period. The most commonly reported AEs were pain of skin 27.8% (470/1692), "thermal burn" 18.7% (316/1692), and erythema 16.0% (271/1692). Among the top 25 AEs reported, no unexpected health events were observed. The reported AEs were qualitatively similar to the pattern seen in clinical studies and the MAUDE database associated with such home-use IPL treatments.

CONCLUSION

This is the first such report documenting AEs for home-use IPL hair removal from a postmarketing surveillance program. These data are supportive of the safety of such home-use low-fluence IPL technology.

The Efficacy of Intense Pulsed Light as a Treatment for Benign Pigmented Lesions on the Dorsal Hand

BACKGROUND

Intense pulsed light (IPL) is a noninvasive therapeutic option to treat benign pigmented lesions by targeting melanin.

OBJECTIVE

The purpose of this study was to assess IPL as a treatment for benign pigmented dorsal hand lesions.

MATERIALS AND METHODS

A total of fifteen subjects, 40 to 73 years old, received 3 monthly IPL treatments over the dorsal hands. Subjects followed up 1 and 3 months after treatment. At every visit, photographs were taken using the VISIA Complexion Analysis System (Canfield Scientific, Fairfield, NJ) and analyzed using the RBX Brown Spots Analysis algorithm. The Clinician Global Aesthetic Improvement Scale and Subject Global Aesthetic Improvement Scale were completed at both follow-up visits.

RESULTS

A total of fifteen subjects completed all six visits. The number of brown spots decreased 9.26% ( p = .0004) and 7.52% ( p = .0132) at each follow-up visit. The mean brown intensity decreased 6.15% ( p = .0183) and 7.67% ( p = .0178), whereas the mean contrast intensity decreased 8.88% ( p < .0001) and 6.60% ( p = .0007) 1 and 3 months after treatment, respectively. The mean Clinician Global Aesthetic Improvement Scale was 2.03 and 2.23, whereas the mean Subject Global Aesthetic Improvement Scale 1 and 3 months after treatment was 1.6 and 1.8, respectively.

CONCLUSION

Objective analysis, along with clinician and subject assessments, showed an improvement in the appearance of benign pigmented lesions in the treated area after 3 IPL treatments.

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.

Clinical and dermoscopic evaluation of melanocytic nevi changes during diode laser hair removal: A prospective study

BACKGROUND

Laser hair removal (LHR) is a common practice with increasing use worldwide. Clinical and dermoscopic changes in melanocytic nevi after LHR have been reported but prospective studies are lacking.

OBJECTIVE

To describe dermoscopic changes of melanocytic nevi at different time points after LHR.

METHODS

Prospective study in a cohort of female patients undergoing diode LHR. Dermoscopic follow-up of at least three nevi on the legs that underwent hair removal. We included three nonexposed nevi on the arms as controls. Two blinded investigators analyzed dermoscopic images, according to variables selected based on the available literature.

RESULTS

Thirty-four patients were included with a total of 148 nevi on the legs and 112 nevi on the arms (controls). 47.9% (71/148) of the nevi on the legs had evidence of dermoscopic changes at the sixth hair removal session, compared to 9.8% (11/112) on controls (p < 0.001). The most frequent change was "bleaching" (41.9%, 62/148). Also, we observed "irregular hyperpigmented areas," and "regression structures" in 5.4% (8/148) and 4.7% (7/148) of the cases at the sixth session, respectively. Neither of these structures were observed in the controls (p < 0.05).

LIMITATIONS

Only females were included; we did not perform histopathological evaluation nor reflectance confocal microscopy of changing nevi.

CONCLUSION

Melanocytic nevi frequently change after diode LHR. The changes cannot always distinguish between LHR induced and melanoma, so we advise avoiding nevi during laser therapies with melanin targets.

Optimization of Photothermal Therapy Treatment Effect under Various Laser Irradiation Conditions

The photothermal effect refers to a phenomenon in which light energy is converted into heat energy, and in the medical field, therapeutics based on this phenomenon are used for anticancer treatment. A new treatment technique called photothermal therapy kills tumor tissue through a temperature increase and has the advantages of no bleeding and fast recovery. In this study, the results of photothermal therapy for squamous cell carcinoma in the skin layer were analyzed numerically for different laser profiles, intensities, and radii and various concentrations of gold nanoparticles (AuNPs). According to the heat-transfer theory, the temperature distribution in the tissue was calculated for the conditions under which photothermal therapy was performed, and the therapeutic effect was quantitatively confirmed through three apoptotic variables. In addition, the laser intensity and the volume fraction of AuNPs were optimized, and the results provide useful criteria for optimizing the treatment effects in photothermal therapy.

Expanded scalp flap combined with laser hair removal to reconstruct facial defects around the hairline

BACKGROUND

Congenital and acquired facial lesions around the hairline can bring huge physical and psychological trauma to patients. At present, reconstruction of this area remains a challenge. In this study, we present an alternative technique to reconstruct the aesthetic units using an expanded scalp flap combined with laser hair removal.

METHODS

We retrospectively reviewed 25 cases of facial lesions around the hairline reconstructed with this surgical technique between May 2014 and May 2020. Expander was implanted under the scalp as designed before the operation. After the expander was fully expanded, the lesion was removed and the scalp flap was transferred. Laser hair removal was performed on the transplanted skin flap 2 weeks after flap transfer.

RESULTS

There were ten cases of postburn scar, nine cases of congenital nevus, four cases of traumatic scar, one case of haemangioma, and one case of nevus sebaceous. The median times of laser treatment was 3 (range, 1-8). The median follow-up time was 11 months, ranging from 1 to 27 months. The colour and texture of expanded flaps were similar to adjacent tissue in all cases. The direction of reserved hair in transferred flaps was consistent with the direction of hair in the recipient area or contralateral hair. There were no complications, such as infection, blistering, discolouration, and ulceration. All patients were satisfied with the appearance of the reconstructed hairline and the surgical outcomes.

CONCLUSIONS

The expanded scalp flap combined with laser hair removal is a feasible and effective technique to reconstruct both sides of the hairline simultaneously from a single donor site with a good colour match and a similar texture and thickness.

Das schöne, glatte Bein: Haarentfernung durch Laser und lichtbasierte Verfahren

Die Fotoepilation zählt zu den meistgefragten nichtchirurgischen Eingriffen in der ästhetischen Dermatologie. Haarlose, glatte Beine gelten dabei als Schönheitsideal.

Fotoepilation mittels Laser oder hochenergetischer Blitzlampen (sog. Intensed-Pulsed-Light-Geräte) stellt ein sicheres und effektives Verfahren dar. Der Wirkmechanismus beruht auf dem Prinzip der selektiven Fotothermolyse, wobei eine gezielte thermische Schädigung pigmentierter Haarfollikel unter Schonung des umliegenden Gewebes erfolgt. Melaninpigment des Haarschaftes absorbiert als Zielchromophor Licht eines speziellen Wellenlängenspektrums und führt durch Wärmediffusion zur Schädigung der für das Haarwachstum wichtigen Stammzellen im äußeren Haarwurzelschaft.

Patienten müssen über die Notwendigkeit wiederholter Behandlungen sowie den häufig nur partiellen und temporären Haarverlust aufgeklärt werden. Dunkle Terminalhaare bei hellen Hauttypen lassen sich effektiv entfernen. Bei dunklen Hauttypen besteht aufgrund des erhöhten epidermalen Melaninvorkommens ein erhöhtes Risiko für Nebenwirkungen wie Verbrennungen, Dyspigmentierungen und Narben. Sehr feine, helle oder rote Haare lassen sich kaum mit konventionellen Fotoepilationsverfahren entfernen. Haarentfernungsgeräte für den Heimgebrauch sind eine kostengünstige, einfach anzuwendende Alternative, weisen aber im Vergleich zur professionellen Fotoepilation eine geringere Effektivität auf.

Aesthetic Treatments in Cancer Patients

Cancer patients are experiencing an increase in overall survival as a consequence of earlier diagnosis and newer effective anticancer therapies. However, cancer survivors often face long-term consequences from their original cancer diagnosis and long-term sequelae of anticancer treatment. Maintaining patients’ quality of life is of paramount importance and this can be accomplished by a multidisciplinary treatment approach, including aesthetic treatments to improve patients’ body image and positively impact their quality of life. In this perspective, we will discuss the importance of aesthetic treatments in cancer patients. In addition, we will summarise the data available regarding the use of several aesthetic treatments such as fillers, botulinum toxin and laser use in cancer patients, their safety, their efficacy, and the specific precautions that need to be implemented in this particular subset of cancer patients.

Safety of Laser Hair Removal in Patients Receiving Systemic Isotretinoin for Acne Vulgaris

BACKGROUND

A few reports on scar and keloid formation in patients receiving systemic isotretinoin have encouraged a conservative approach in which laser procedures are delayed during and 6 to 12 months after the completion of treatment.

OBJECTIVE

To assess the safety of laser hair removal with alexandrite, diode, and Nd:YAG lasers in patients receiving systemic isotretinoin treatment.

MATERIALS AND METHODS

Fifty-two patients who underwent laser hair removal during isotretinoin treatment were retrospectively analyzed and compared with a control group for side effects.

RESULTS

There were 48 female and 4 male patients. The average isotretinoin dose was 33.7 mg/d. The average interval between the start of isotretinoin treatment and the first laser hair removal was 39.3 days. The mean number of sessions under treatment was 4.1. Three patients had temporary crusting, and 1 patient had a small area of temporary hypopigmentation. Five (9.6%) patients in the control group had crusting. The incidence of side effects was not significantly different between the 2 groups (p > .05). Neither patients in the isotretinoin group nor those in the control group experienced blistering, pigmentation, ulceration, and scar or keloid formation.

CONCLUSION

Laser hair removal is a safe procedure with alexandrite, diode, and Nd:YAG lasers in patients receiving systemic isotretinoin.

Using blend wavelengths in order to improve the safety and efficacy of laser hair removal

BACKGROUND

As the pursuit for a safe and effective device for laser hair removal continues, the use of simultaneous multiple wavelengths in a single device requires further exploration.

AIM

To evaluate the safety and efficacy of a novel multi-wavelength laser device for hair removal.

PATIENTS AND METHODS

This retrospective cohort study included adult participants of both sexes with Fitzpatrick skin types of III and IV. Hairy sites were treated by a multiple wavelength (810nm, 940nm, and 1064nm) laser device (Primelase, Coccoon medical, Barcelona, Spain). Laser parameters included: fluence of 14-20 J/cm² , pulse duration of 7-30 ms, and spot size of 20*9 mm² . Participants underwent up to 7 treatments at 6-8 weeks intervals and were followed for 6 months after the last treatment session. "Before" and "after" clinical photographs were acquired and were used to evaluate efficacy by 2 independent dermatologists. They employed the Global Aesthetic Improvement Scale (GAIS; scale of 0 [no improvement] to 4 [excellent improvement; Over 75% hair reduction]). Participants' satisfaction was rated on a scale of 1 (not satisfied) to 5 (very satisfied). Pain perception and adverse events were recorded as well.

RESULTS

Eighteen participants (6 men, 12 women) were included with a total of 49 treatment sites. Mean hair reduction was 3.6 out of 4 in the GAIS. Participants' satisfaction rate was high (mean 4.5). Beside mild transient discomfort during the procedure, no adverse events were recorded.

CONCLUSION

The use of a multiple wavelengths' laser device is safe and effective for hair removal.

Das schöne, glatte Bein: Haarentfernung durch Laser und lichtbasierte Verfahren

Die Fotoepilation zählt zu den meistgefragten nichtchirurgischen Eingriffen in der ästhetischen Dermatologie. Haarlose, glatte Beine gelten dabei als Schönheitsideal.

Fotoepilation mittels Laser oder hochenergetischer Blitzlampen (sog. Intensed-Pulsed-Light-Geräte) stellt ein sicheres und effektives Verfahren dar. Der Wirkmechanismus beruht auf dem Prinzip der selektiven Fotothermolyse, wobei eine gezielte thermische Schädigung pigmentierter Haarfollikel unter Schonung des umliegenden Gewebes erfolgt. Melaninpigment des Haarschaftes absorbiert als Zielchromophor Licht eines speziellen Wellenlängenspektrums und führt durch Wärmediffusion zur Schädigung der für das Haarwachstum wichtigen Stammzellen im äußeren Haarwurzelschaft.

Patienten müssen über die Notwendigkeit wiederholter Behandlungen sowie den häufig nur partiellen und temporären Haarverlust aufgeklärt werden. Dunkle Terminalhaare bei hellen Hauttypen lassen sich effektiv entfernen. Bei dunklen Hauttypen besteht aufgrund des erhöhten epidermalen Melaninvorkommens ein erhöhtes Risiko für Nebenwirkungen wie Verbrennungen, Dyspigmentierungen und Narben. Sehr feine, helle oder rote Haare lassen sich kaum mit konventionellen Fotoepilationsverfahren entfernen. Haarentfernungsgeräte für den Heimgebrauch sind eine kostengünstige, einfach anzuwendende Alternative, weisen aber im Vergleich zur professionellen Fotoepilation eine geringere Effektivität auf.

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.

The effectiveness of Cyperus rotundus essential oil in reducing the side effects of laser hair removal

BACKGROUND

In many ailments, Cyperus rotundus is an effective and safe treatment option. Flavonoids in the oil have anti-inflammatory and analgesic properties. There have been no randomized controlled trials comparing topical C rotundus oil to the available allopathic modalities for treating post-hair removal laser side effects.

OBJECTIVES

Participants in this study were prospectively evaluated for the efficacy of C rotundus essential oil, compared with hydrocortisone and saline, in managing pain and erythema after laser hair removal.

METHODS

Eligible participants (n=153) were randomly assigned to one of three study groups: topical C rotundus oil (group 1), hydrocortisone (group 2), or saline (group 3). The following methods were used to assess the results: The Wong-Baker FACES Pain Scale is used to rate pain. Erythema was graded on a six-point scale: "no erythema," "slight erythema," "marked erythema," "severe erythema without vesicles," and "severe erythema with vesicles."

RESULTS

In terms of anti-inflammatory effects, C rotundus oil and hydrocortisone did not differ significantly (P >.05). However, statistically significant differences in the analgesic effect (P.05) were observed, favouring the oil.

CONCLUSIONS

Cyperus rotundus essential oil is a safe and cost-effective treatment for post-laser pain and erythema.

Skin Quality - A Holistic 360° View: Consensus Results

Introduction

Skin quality is an important component of human attractiveness. To date, there are no standardized criteria for good skin quality. To establish a consensus for good skin quality parameters and measurement and treatment options, a virtual skin quality advisory board consisting of a global panel of highly experienced aesthetic dermatologists/aesthetic physicians was convened.

Methods

A total of 10 dermatologists/aesthetic physicians served on the advisory board. A modified version of the Delphi method was used to arrive at consensus. Members accessed an online platform to review statements on skin quality criteria from their peers, including treatment and measurement options, and voted to indicate whether they agreed or disagreed. Statements that did not have agreement were modified and the members voted again. Consensus was defined as: strong consensus = greater than 95% agreement; consensus = 75% to 95% agreement; majority consent = 50% to 75% agreement; no consensus = less than 50% agreement.

Results

There was strong consensus that good skin quality is defined as healthy, youthful in appearance (appearing younger than a person's chronological age), undamaged skin and that skin quality can be described across all ethnicities by four emergent perceptual categories (EPCs): skin tone evenness, skin surface evenness, skin firmness, and skin glow. The EPCs can be affected by multiple tissue layers (ie, skin surface quality can stem from and be impacted by deep structures or tissues). This means that topical approaches may not be sufficient. Instead, improving skin quality EPCs can require a multilayer treatment strategy.

Conclusion

This global advisory board established strong consensus that skin quality can be described by four EPCs, which can help clinicians determine the appropriate treatment option(s) and the tissue or skin layer(s) to address. Skin quality is important to human health and wellbeing and patients' perception for the need for aesthetic treatment.

What else than eyes need special protectors during laser hair reduction sessions?

Complications of laser hair reduction should be classified not only to skin and ocular complications but to skin, ocular, and scalp hair complications. Do not forget the plumes. Awareness about laser dangers is very critical. In this way, able to progress the security of both patients and laser providers. Does Nd: YAG cause more bad effect than Alexandrite on scalp hair melanin of laser providers and why? The study aimed at detecting the effect of cumulative exposure to scattered beam during laser hair reduction on the laser providers which may cause unexpected scalp hair melanin affection. The study included 150 female subjects: One hundred medical personnel engaged in laser-assisted hair reduction procedure; half of them were wearing head cover (hijab) and 50 female subjects not dealing with hair reduction laser systems (half of them were wearing hijab). Two laser devices were used: Alexandrite laser (GentleLase PRO® 755 nm, Candela Corp., Wayland, MA, USA) and neodymium-doped Yttrium Aluminium Garnet (Nd: YAG) (Synchro HP 1064 nm, Deka M.E.L.A s.r.l., Calenzano (FI), Italy) laser. A significant higher number of grey hairs in medical personnel (P < 0.001) was evident at the initial examination and at each follow-up visit thereafter. The number of grey hairs at initial assessment, after 6 months and after 1 year, was significantly higher in medical personnel dealing with Nd: YAG laser than those using long-pulsed Alexanderite laser (P < 0.001 each). A noteworthy positive correlation was found between working years, grey hair number at the start of study, and the progression (excess) in number of grey hairs after 1 year regardless of the laser system used. It seems that scalp hair pigment needs specific protection as does the eye pigment. Greater attention should be paid to possible long-term hazards particularly on service providers.

Multipass low fluence, high-frequency 755-nm alexandrite laser versus high fluence, low-frequency 1064-nm long-pulsed Nd: YAG laser in axillary hair reduction of dark skin phototypes: an intra-individual randomized comparative study

BACKGROUND

Laser hair removal has become popular means of achieving hair reduction with improved quality of life.

OBJECTIVE

This study aimed to assess the safety and efficacy of Multipass low fluence, high-frequency 755-nm Alexandrite laser versus the high fluence, low-frequency 1064-nm long-pulsed Nd: YAG laser on axillary hair reduction in women with dark skin phototypes.

PATIENTS AND METHODS

This study was carried out on 30 adult women [skin type, IV-VI)] who seek axillary hair reduction. These subjects were adjusted to receive 5 laser sessions with a 1-month interval. One side received high fluence, low-frequency 1064-nm laser where the other side received multipass low fluence, high-frequency 755 nm laser. The follow up was done using photographs, folliscope, patients' visual analog pain scale.

RESULTS

The mean percentage of hair density reduction showed significant improvement in both treated sides being higher in the Alex treated side with corresponding significant decreases in the mean hair thickness.

CONCLUSION

Multipass low fluence, high-frequency 755-nm Alex laser practice was verified to be safe and effective for hair removal in dark skin phototypes compared to the high fluence, low frequency 1064-nm long pulsed Nd:YAG laser.

Combination of Extended Paramedian Forehead Flap and Laser Hair Removal in the Reconstruction of Distal Nasal Defect

AIM

The study sought to determine whether extended forehead flap by using part of the scalp combined with laser hair removal is a practical approach when repairing distal nasal defect.

METHODS

A retrospective study was conducted with 6 patients who underwent reconstruction of nasal defects with extended forehead flaps (including scalp combined with subsequent laser hair removal) at Shanghai Ninth People's Hospital between June 2016 and December 2018. Surgical data collected included age, causes of defects, sizes of defects, invaded nasal subunits, implantation of tissue expander, time elapsed between the formation of defects and surgical treatments, sessions of laser hair removal, and follow-up results. All patients had nasal defects after removal of a benign nevus (diameter, >1.5 cm), which invaded distal nasal subunits (including the nasal tip, soft triangle, columella, and nasal ala) and could not be repaired using adjacent tissue. Preoperative and postoperative assessments of esthetic outcomes were analyzed, including skin color and texture match, appearance deformity, and scar appearance.

RESULTS

All 6 female patients (ages 4 to 24 years) accepted the extended forehead flap technique and subsequent laser hair removal treatments. Among the 6 patients, 2 had nasal tip defects, 1 had a columella nasi defect, one had an alar defect, and 2 had multiunit defects. All transferred forehead flaps survived with no necrosis and underwent 2 to 5 subsequent laser hair removal treatments. The color and texture of the transferred flaps was similar to the adjacent skin in all patients. All patients were satisfied with the final outcome of the reconstructed nose with no obvious scarring during follow-up.

CONCLUSIONS

Extending the forehead flap using the scalp is a practical and safe approach for the repair of large and distal nasal defects. Subsequent laser hair removal can eliminate the hair follicles of the scalp and improve the appearance and color of the flap.

Efficacy and safety of triple wavelength laser hair reduction in skin types IV to V

BACKGROUND

Laser hair reduction is one of the most common laser procedures in dermatology. Laser systems available are Ruby at 694 nm, Alexandrite (755 nm), Diode (810nm), and Nd:YAG (1064 nm). Recently, devices presenting a combination of wavelengths have shown to produce high effective hair reduction with no related risks. This study was conducted with the Soprano Ice Platinum (Alma Lasers, GMBH, Germany) that emits a combination of three wavelengths at 755, 810, and 1064 nm in a single pulse.

AIMS

To establish the efficacy and safety of novel triple wavelength laser hair reduction technology in skin types IV to V.

PATIENTS AND METHODS

This was an investigator initiated, single-center, prospective clinical study conducted between December 2017 and June 2019 with a total of 25 patients (23 female and two male) above 18 years with skin types IV and V, areas included are face, beard, neck, chest, and others.

RESULTS

Hair reduction was assessed using the physician GAIS (global esthetic improvement scale) score: no results 0% reduction, poor 0%-25% reduction, average 25%-50%, good 50%-75%, and excellent 75%-100%. All 25 patients (mean age 28 years, range 18-52 y/o) completed all six sessions of the study.

CONCLUSION

Objective clinical assessment of hair reduction using the physician GAIS score in 90 anatomical sites scores an excellent reduction in 95.5% areas and good reduction in 80% areas. This current study shows that a synergistic combination of three diode laser wavelengths used for hair removal (755, 810, 1064 nm) is effective and safe to use in subjects skin types IV and V for facial and body hair.

Perianal Reactivation of Herpes Simplex Virus Type 2 After Laser-Assisted Hair Removal

ABSTRACT

We report a case of perianal reactivation of herpes simplex virus type 2 in a 27-year-old man, who was HIV positive with good immunovirological status, after a laser-assisted (alexandrite) hair removal session. We discuss the clinical and laboratory features and the role of prophylaxis with antivirals, particularly in certain patients such as immunocompromised ones.

Health Insurance Coverage of Permanent Hair Removal in Transgender and Gender-Minority Patients

Importance

Hair removal can be an essential component of the gender affirmation process for gender-minority (GM) patients whose outward appearance does not align with their gender identity.

Objective

To examine the health insurance policies in the Affordable Care Act (ACA) marketplace and Medicaid policies for coverage of permanent hair removal for transgender and GM patients and to correlate the policies in each state with statewide protections of coverage for gender-affirming care.

Design and Setting

Private health insurance policies available on the ACA marketplace and statewide Medicaid policies were examined in a cross-sectional study from September 1 to October 31, 2019, and January 17 to 30, 2020. Policies were assessed for coverage of permanent hair removal. Language concerning hair removal was found in each policy's medical or clinical coverage guidelines and separated into general categories.

Main Outcomes and Measures

Logistic regression analyses were performed to compare Medicaid policies and ACA policies in states with and without transgender protections.

Results

A total of 174 policies were analyzed, including 123 private insurance policies and 51 statewide Medicaid policies. Of these policies, 8 (4.6%) permitted the coverage of permanent hair removal without explicit restrictions. The remaining 166 policies (95.4%) broadly excluded or did not mention gender-affirming care; prohibited coverage of hair removal or did not mention it; or only permitted coverage of hair removal preoperatively for genital surgery. The ACA marketplace policies in states without transgender care protections were less likely to cover hair removal without restrictions than ACA policies in states with protections (2 of 85 policies [2.4%] in states without transgender care protections vs 5 of 38 policies [13.2%] in states with transgender care protections), and Medicaid policies were less likely to cover preoperative or nonsurgical hair removal compared with ACA policies (6 of 51 Medicaid policies [11.8%] vs 47 of 123 ACA policies [38.2%]).

Conclusions and Relevance

Despite adoption of statewide restrictions on GM health care exclusions by several states, most Medicaid and ACA policies examined in this study did not cover permanent hair removal for transgender patients. Many GM patients seeking hair removal may be required to pay out-of-pocket costs, which could be a barrier for gender-affirming care.