Laser Treatment in Hirsutism: An Update

Aesthetic Procedures and Psychological Wellbeing in Saudi College Students: An In-Depth Exploration

Purpose

Minimally invasive aesthetic procedures are widely popular among the youth. Despite their prevalence, there is a significant gap in the research concerning the relationship between these procedures and psychological wellbeing, as well as an insufficient exploration of the barriers and motivators influencing their adoption, this study aims to address these gaps.

Methods

This cross-sectional study has utilized a secure online survey directed at Saudi university students as the target population. The survey was consisting of 18-item electronic questionnaire including of 4 parts (demographical data, history of psychological illness and screening of current psychological wellbeing using WHO-5 well-being tool, history of doing cosmetic procedure, or willingness to do in the future, barriers and motivators to do cosmetic procedures), and it was distributed across multiple social media platforms.

Results

A total of 8443 college students completed the study questionnaire. Exactly 1096 (13%) of the students underwent a cosmetic procedure. The most reported procedures were laser hair removal (9.1%), filler (5.3%), skin boosters (2.8%), and Botulinum toxin A injections (Botox) (2.6%). The most ranked motivators were being painless, with no side effects (8.8 out of 10), followed by being free (8.0 out of 10) and enhancing self-confidence (7.4 out of 10).

Conclusion

No significant difference recorded at the overall psychological well-being score between who underwent cosmetic procedures and who did not.

Cosmetic considerations after breast cancer treatment

Treatments for breast cancer can have an array of adverse effects, including hair loss, scarring, and irritated skin. These physical outcomes can, in turn, lead to body image concerns, anxiety, and depression. Fortunately, there is growing evidence that certain cosmetic therapies can improve patient self-image. Here we review various cosmetic treatment options including hair camouflage, eyebrow and eyelash camouflage, treatments for hirsutism, nipple and areola tattooing, post-mastectomy scar tattooing, treatments for dry skin/xerosis, removal of post-radiation telangiectasias, and lightening of post-radiation hyperpigmentation. For each patient concern, we report potential procedures, clinical evidence of impact on quality of life, special considerations, and safety concerns. This article aims to equip dermatologists with resources so that they may effectively counsel breast cancer survivors who express treatment-related cosmetic concerns.

Impact of Laser Therapy on the Quality of Life in Women Living With Polycystic Ovary Syndrome-Associated Hirsutism: An Observational Study

INTRODUCTION

This study aimed to observe the impact of laser-assisted hair removal (LAHR) on the quality of life in women with polycystic ovary syndrome (PCOS)-associated hirsutism.

METHODOLOGY

An observational study was conducted on 172 women living with PCOS at a specialized clinic. The Dermatology Life Quality Index (DLQI) and Ferriman-Gallwey (FG) score were employed to assess the quality of life and severity of hirsutism, respectively. Laser therapy was administered using ruby diode or alexandrite lasers. Follow-up on the DLQI and FG score assessment was done at 12-, 18-, and 24-week post-treatment.

RESULTS

The number of cases that reported stress, anxiety, and depression reduced over time. However, there was no correlation between the patient-reported decrease and DLQI scores. The FG score was significantly related to mental health. The severity of the hirsutism impacted mental health. The regrowth of hair at six months indicated limited long-term efficacy LAHR.

CONCLUSION

 LAHR significantly improves the quality of life in the short term for women living with PCOS. However, the short-term benefit of the therapy indicates a need for research to find new treatment strategies.

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.

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.

Methods to Overcome Poor Response and Challenges of Facial Laser Hair Reduction

Unwanted facial hair is a relatively common problem that can be emotionally distressing. Laser hair reduction has become the treatment of choice for removal of facial hair, replacing more traditional methods of hair removal. To achieve maximum treatment efficacy while minimizing side effects, clinicians must practice proper patient selection and counseling, proper laser procedure, and posttreatment care. The treatment parameters should be individualized for each patient depending on various factors. A favorable treatment outcome depends on three major factors: proper patient selection, use of a suitable laser system, and an experienced laser operator. The aim of this article is to review the factors responsible for possible poor outcomes of laser hair reduction in the facial area and to describe steps that should be followed to minimize side effects and enhance results following facial hair reduction by laser.

Comparison of efficacy of diode laser in patients of facial hirsutism with normal dehydroepiandrosterone sulfate and dihydrotestosterone versus deranged dehydroepiandrosterone sulfate and dihydrotestosterone level - A Longitudinal study

INTRODUCTION

Hirsutism is defined as an excessive terminal hair growth in female over male pattern distribution areas. Traditional methods of hair removal have been replaced by lasers.

OBJECTIVE

To observe the effect of diode laser in hirsutism patient with normal and deranged dehydroepiandrosterone sulfate (DHEAS) and dihydrotestosterone (DHT) level.

MATERIALS & METHODS

50 patients of facial hirsutism with skin type IV and V were enrolled. 18 patients with deranged dehydroepiandrosterone sulfate and dihydrotestosterone level were allocated in group A whereas 16 patients with normal level were allocated in group B. Three sittings of diode laser was done in all subjects with varying session within a period of 6 months.

RESULT

At first follow-up visit, the percentage of hair reduction was fair in 62.5% of patients in group B and 16.7% of patients in group A, whereas at second follow-up visit, it was good in 56.3% of patients in group B and 11.1% of patients in group A. Increase in vellus hair and reduction in percentage of terminal hair were more significant in group B. Hair free interval and satisfaction level was significantly higher in group B.

CONCLUSION

Diode laser is effective mode of treatment in hirsutism patient irrespective of hormone level. But, the effect is observed to be more efficacious in patients with normal DHEAS & DHT level.

Challenges in treatment of patients with non-classic congenital adrenal hyperplasia

Congenital adrenal hyperplasia (CAH) due to 21α-hydroxylase deficiency (21OHD) or 11β-hydroxylase deficiency (11OHD) are congenital conditions with affected adrenal steroidogenesis. Patients with classic 21OHD and 11OHD have a (nearly) complete enzyme deficiency resulting in impaired cortisol synthesis. Elevated precursor steroids are shunted into the unaffected adrenal androgen synthesis pathway leading to elevated adrenal androgen concentrations in these patients. Classic patients are treated with glucocorticoid substitution to compensate for the low cortisol levels and to decrease elevated adrenal androgens levels via negative feedback on the pituitary gland. On the contrary, non-classic CAH (NCCAH) patients have more residual enzymatic activity and do generally not suffer from clinically relevant glucocorticoid deficiency. However, these patients may develop symptoms due to elevated adrenal androgen levels, which are most often less elevated compared to classic patients. Although glucocorticoid treatment can lower adrenal androgen production, the supraphysiological dosages also may have a negative impact on the cardiovascular system and bone health. Therefore, the benefit of glucocorticoid treatment is questionable. An individualized treatment plan is desirable as patients can present with various symptoms or may be asymptomatic. In this review, we discuss the advantages and disadvantages of different treatment options used in patients with NCCAH due to 21OHD and 11OHD.

Efficacy of 810 nm diode laser in hair reduction in Indian subpopulation using a novel Gabor filter-based detection software and hair algorithm

BACKGROUND

Diode laser (810 nm) is frequently employed for hair reduction. There are few studies determining the efficacy in Indian population.

OBJECTIVES

Assessment of efficacy and safety of 810 nm diode laser in facial/axillary hair reduction and objective assessment of the improvement with dermoscopy, photographs, and novel Gabor filter-based hair detection algorithm.

METHODOLOGY

This hospital-based study included 40 adult women with 108 treatment sites over 5.4 sessions (range 4-8). Evaluation of treatment areas (hair texture, density) was done using modified Ferriman-Galwey scoring. Photography and dermoscopic images were taken before each session and 6 weeks after the last. Immediate and delayed adverse reactions were noted. Assessment of efficacy was done by patient, principal, and blinded investigator using Global Aesthetic Improvement scale (GAIS) and hair detection algorithm (evaluating characteristics of dermoscopic hair).

RESULTS

The fluences ranged from 16 to 29 Joules/cm² with pulse width of 30 ms. Upper lip (n = 29, 26.9%) and chin (n = 25, 22.1%) were commonly treated areas. Improvement in hair texture and density (reduction in uniformly distributed, terminal hair from 37.1% to 13.9%) was statistically significant (p < 0.0001). Excellent improvement of 75-100% (GAIS) was noted by principal and blinded investigator in 24.1% and 33.3% total sites, respectively. The median improvement, calculated by the algorithm, was 60% for side locks, 53.9% for axilla, 24.1% for upper lip, and 14.9% for chin. Axilla and upper lip were sites associated with maximum discomfort. Epidermolysis and paradoxical hypertrichosis were seen in five patients each.

CONCLUSION

The 810 nm diode laser is safe and effective in the reduction of dark, coarse terminal hairs in Fitzpatrick skin types III-V. Inter-observer variation and investigator bias in the assessment of efficacy can be successfully overcome by using the algorithm.

Effect of Different Pulse Durations on the Efficacy of Long-Pulsed Alexandrite-Assisted Hair Removal; A Split-Face Comparison Study

Introduction: Laser-assisted hair removal is widely used by a large number of patients complaining of unwanted hair. However, little is known about the effect of varying the pulse duration on clinical results and side effects. This study aimed to investigate the effectiveness of hair removal using an alexandrite laser with different pulse durations. Methods: Fifty female patients with facial hirsutism were subjected to a hair removal procedure with an alexandrite laser, using 3 and 10 milliseconds pulse durations on each side of the face every 5 weeks for three sessions. Photographs were taken and hair counts were checked before the treatment and one month postoperatively. Results: one month after the laser treatment, the clearance rate was 56% with both 3 and 10 milliseconds pulse durations. There was not any significant difference in clinical efficacy or the side effect profile. Conclusion: Using a 755 nm alexandrite laser for hair removal is an effective and safe method for delaying hair regrowth and this delay is not markedly different by increasing the pulse duration from 3 to 10 milliseconds.

Comparative study of the clinico-trichoscopic response to treatment of hirsutism with long pulsed (1064 nm) Nd:YAG laser in idiopathic hirsutism and polycystic ovarian syndrome patients

Treatment of hirsutism is usually resistant, and from medical management to laser hair reduction, the treatment of hirsutism and its assessment are the most challenging. The aim of the study was to compare the response to treatment by laser hair reduction with long pulsed (1064 nm) Nd:YAG laser in patients of idiopathic hirsutism and polycystic ovarian syndrome (PCOS) by clinical and trichoscopic assessment. A hospital-based comparative, observational prospective study was carried out on female patients with hirsutism over a period of 18 months with two groups of participants: fifty women with idiopathic hirsutism (group A) and fifty with PCOS (group B). Laser hair reduction was done with long pulsed (1064 nm) Nd:YAG laser in both groups up to six sessions, 4 weeks apart and followed for 3 months post last laser session. After the sixth session of laser hair reduction, excellent response (> 75% reduction) from baseline was seen in 70% of patients in group A and in 54% of patients in group B. After 3 months of follow-up of the last laser session, it was found that the results persisted in patients with idiopathic cause than in those due to PCOS, seen both clinically and trichoscopically with decrease in hair shaft thickness, hair shaft colour, terminal vs. vellus hair ratio and hair density per cm². Hirsutism due to idiopathic cause responds better to laser hair reduction with long pulsed (1064 nm) Nd:YAG laser than that due to PCOS, due to underlying hormonal imbalance in the latter group. Follow-up of only up to 3 months after last laser session was done and tricoscan was not done.