Laser hair removal complications and the associated risk factors at a tertiary dermatology center: a case-control study.

Laser hair removal (LHR) has been established as a safe and efficient method for eliminating unwanted hair. This study aimed to investigate the frequency of LHR complications and assess the contributing factors. During one year, 16,900 patients undergoing LHR therapy were evaluated for complications. For each case, two external controls were selected (matched based on age, sex, Fitzpatrick skin type (FST) III-IV, and the treated anatomical region). To assess the impact of anatomical region on complication occurrence, each patient was used as their internal control if another area was treated during the same session. GEE analysis was used for statistical analysis.The incidence of LHR complications was calculated to be 0.69%. The most common complications were petechia, purpura, and ecchymosis (31.66%) followed by pigmentation changes (20.0%). LHR complications were most commonly observed in the lower limbs (32.0%), face and neck (23.3%), and genitalia and thighs (22.3%), respectively. Possible risk factors were younger age (OR = 0.74, P-value ≤ 0.001), operating LHR in the head and neck (OR = 5.8, P-value = 0.022), utilization of the alexandrite laser (OR = 2.32, P-value = 0.011), and fluence in the Alexandrite laser (OR = 3.47, P-value = 0.003).Overall, the results of this study indicate that LHR is generally a safe method for removing unwanted hair. However, factors such as younger age, treatment of the facial area, and use of the alexandrite laser especially with higher fluence levels in patients with FST III-IV were identified as potential risk factors.

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.

Study on the efficacy and safety of a high-power triple wavelength diode laser (810, 940, 1060 nm) for removing fine and less pigmented facial hair on Asian skin.

INTRODUCTION: Performing laser hair removal treatments on dark skin is limited by the quantity of melanin within the skin. To minimize side effects, lower values of fluence are selected when using standard 755 or 810 nm diode lasers. However, this approach may limit the effectiveness of the procedure, particularly when treating areas with thin and less pigmented hair, which is often the case in facial regions. To improve results, high-power triple wavelength diode lasers can be used. This study aims to assess the efficacy, safety, and comfort of treatments that remove facial hair with a high-power triple wavelength diode laser (810, 940, and 1060 nm) in static mode on Asian patients with thin and less pigmented hair. MATERIALS AND METHODS: A single-center retrospective cohort study was carried out using a high-power triple wavelength diode laser (810, 940, and 1060 nm), with a 2.7 cm2 spot size, on faces with thin and less pigmented hair. The study comprised 23 subjects with Fitzpatrick skin types IV and V. Effectiveness was measured by counting the hairs that appeared in high-resolution photos taken prior to and following the procedure, in addition to the Global Aesthetic Improvement Scale (GAIS). Furthermore, mathematical 3D simulations were created on the COMSOL Multiphysics® software to allow for comparisons to be made with regard to thermal damage sustained by the hair follicles and epidermal heating. Assessments were also made in relation to side effects. RESULTS: An average of 66% hair reduction was observed. Patient satisfaction was between 4 and 5 points on the GAIS scale, indicating that the treatment was very well received and tolerated. Adverse side effects were not observed. CONCLUSION: It can be concluded that the use of a high-power triple wavelength diode laser (810, 940, and 1060 nm) is safe and effective for the treatment of very fine and less pigmented facial hair on Asian skin. Furthermore, a triple wavelength (810, 940, and 1060 nm) laser is absorbed less by the melanin in the skin, enabling the use of higher fluences in stamping mode, with greater efficacy and safety for darker skin.

What are the Factors That Induce Paradoxical Hypertrichosis After Laser Hair Removal?

BACKGROUND: Laser hair removal (LHR) is one of the most requested cosmetic procedures worldwide. A rare side effect is the appearance of excess hair around previously treated areas, known as paradoxical hypertrichosis. OBJECTIVES: The aim of this study was to retrospectively identify the cause of this side effect. METHODS: This study included all patients who underwent LHR at our center between November 2018 and November 2020. Alexandrite laser hair removal (HR) or diode laser super hair removal (SHR) was performed in 70% and 30% of cases, respectively. Clinical features and daily habits of patients with and without postlaser hypertrichosis were compared. RESULTS: Of the 7381 patients who received LHR, 25 patients (0.34%) demonstrated an increase in hair growth compared to baseline. Of these 25 patients, 24 had been treated with alexandrite laser HR (P < .01). The most common site was the upper arm, followed by the periareolar area. Daily sun protection was associated with a significantly lower incidence of hypertrichosis (P < .05), as was confirmed and shown to be independent of Fitzpatrick skin type by binary logistic regression analysis (odds ratio = 0.41, P < .05). CONCLUSIONS: In our clinic, we observed paradoxical hypertrichosis after laser hair removal in a small minority of cases, as described by others. We did not observe differences in incidence related to skin type, but daily sun protection and LHR with diode laser SHR were associated with significant reductions in incidence rates. In addition to previously reported common sites, we also identified the periareolar area as a high-risk region.

Extreme pubic hair removal as a potential risk factor for recurrent urinary tract infections in women.

Urinary tract infections (UTIs) are the most common infections experienced by women. Previously, scalp and facial hair in men have been shown to inhibit the growth of pathogenic bacteria. Here we hypothesize that having hairy genitalia might protect women from UTI. This study investigated grooming habits and occurrence of UTIs in the past 12 months in 2409 women (aged 18-45). Women who reported removing all their pubic hair at least weekly were defined as extreme groomers (66.8%). We collected additional information on covariates including age, having a first UTI at or before age 15, spermicide use, having a new sex partner, and frequency of sexual intercourse during the past year. Extreme grooming was not associated with the risk of being diagnosed with UTI (OR = 1.17, 95% CI = 0.90-1.52), but was associated with a higher risk of recurrent UTIs, defined as three or more UTIs within 12 months (OR = 3.09, 95% CI = 1.35-7.06), after controlling for age, history of UTIs, and sexual practices. Other studies have found that hygienic purposes are the most common motivations for pubic hair removal. These results suggest that along with their pubes, women may be getting rid of important microbial niche and protection against recurrent UTIs.

Pathergy-like reaction induced by laser hair removal in a patient with Behçet disease.

Behçet disease (BD) is a rare systemic vasculitis of unknown etiology, primarily characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Pathergy test positivity is a nonspecific inflammatory response of the skin to trauma and supports the diagnosis. Recently, new inducers of pathergy reactions have been identified, for example, the placement of dental braces and laser hair removal. Our clinical case highlights the importance of thinking about this potential pathergy inducer in BD patients, to improve their quality of life and avoid complications.

Umbilical seborrheic keratosis-like lesion developing after diode laser hair removal in an 18-year-old patient.

OBJECTIVE: to report a possibly novel complication of laser hair removal. CASE REPORT: a white-skinned 18-year-old patient discovered an umbilical, brown, and raised lesion while shaving before his second diode laser hair removal session. He sought consultation before his fourth laser session since the lesion further thickened and darkened. Dermoscopy showed no pigmented network, but a few comedo-like openings within an erythematous-light brown scaly and fissured papule, "moth-eaten" borders, and a central crust due to manipulation, suggesting the diagnosis of seborrheic keratosis. We noted that the laser fluence was increased on the umbilical region where hair seemed resistant to treatment. The patient denied a recent history of local sun tanning, sunburns, inflammation, drainage, or manipulation. The lesion cleared, with no short-term relapse, after one session of cryotherapy. CONCLUSION: the development of a seborrheic keratosis-like lesion on a densely haired non-sun-exposed umbilicus of a young patient, following pre-laser shaving and high-fluence hair removal diode laser sessions, could have implicated triggering irritation and/or keratinocyte stimulation by red light-engendered reactive oxygen species (ROS) in the skin with silent epidermal mosaicism.

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.

Evaluating the effectiveness of laser hair reduction using a home use laser in comparison to a Diode laser.

BACKGROUND: Lasers of different wavelengths have been developed for use in permanent hair reduction. An increase in the manufacturing of home-use laser hair removal devices allows for these treatments to be performed in the comfort of your own home at an affordable cost. OBJECTIVE: To evaluate the effectiveness of permanent hair reduction using a Diode laser in comparison to the Silk'n™ Flash and Go Lux (475-1200 nm) home-use laser. METHODS: Fifteen females received six axillae laser hair removal treatments at two to four-week intervals using either a professional laser or home-use laser device. Photographs and hair counts were taken before each treatment and at a three week follow up. A T-test was used to evaluate statistical significance, and regression analysis to determine a difference in the effects. Pain scores and side effects were recorded by a visual analogue scale in a satisfaction questionnaire. RESULTS: The professional laser showed an overall hair reduction of 85% on the right axilla and 88% on the left axilla. The home-use laser showed an overall reduction of 52% on the right axilla and 46,3% on the left axilla. Mild side effects were experienced for both laser devices. There were no serious adverse effects reported, safety features are effective to a certain extent. CONCLUSION: The Flash & Go Lux home-use laser can effectively reduce hair at a slower rate than the Diode laser. The home-use laser device offers protection against accidental exposure to light and use on darker skin types. Risks of retinal damage due to long-term exposure to home-use laser light are still cause for concern.

Reasonable Accommodation and Disparate Impact: Clean Shave Policy Discrimination in Today's Workplace.

This article examines Bey v. City of New York - a recent Second Circuit case where four Black firefights suffering from Pseudofolliculitis Barbae (a skin condition causing irritation when shaving which mostly affects Black men) challenged the New York City Fire Department's Clean Shave Policy - with an intersectional approach utilizing legal theories of racial, disability, and religious discrimination.

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.

Novel laser hair removal in all skin types.

BACKGROUND: Laser has been long accepted as a solution for excess or unwanted hair growth yet traditional lasers are not always ideal for safe and effective outcome for all skin types and hair characteristics. A diode laser module combining three wavelengths (755, 810, and 1064 nm) in a single pulse was developed to provide a fast and long-term solution for subjects with various profiles. AIMS: To evaluate the safety and efficacy of a Triple wavelength diode laser module for hair removal treatment in all skin types (Fitzpatrick I-VI). SUBJECTS AND METHODS: This was a prospective, dual centered, single-arm study. Subjects were treated with a novel diode laser module. Thirty-six subjects were enrolled, sixteen with Fitzpatrick skin types I-IV (46%) and twenty with Fitzpatrick skin types V-VI (54%). Treatment areas were axilla and bikini lines. Subjects underwent 4 treatment sessions at 6 weeks ± 5 days intervals and attended a follow-up visit 3 months after the last treatment session. 2D digital photographs were taken at baseline and at the follow-up visit, and a hair count was conducted by three blinded evaluators. RESULTS: A significant reduction in hair count between baseline and the 3-month follow-up visit was observed in both axilla and bikini lines for all skin types. The mean hair reduction was 41.5 ± 19.4% and 48.1 ± 20.9% in the axilla and bikini line, respectively. A significant hair reduction was also observed within skin type groups; mean hair reduction 45.5 ± 16.9% and 40.3 ± 17.2% in skin types I-IV and V-VI, respectively, indicating similar efficacy for both light and dark skin types. No serious adverse events were reported. CONCLUSIONS: This study demonstrates that the Soprano Titanium laser platform is safe and effective for hair removal treatment in all skin types.

Comparative effectiveness of ice packs versus topical lidocaine-prilocaine mixture for pain control in laser hair removal of the axilla: A rater-blinded randomized controlled trial.

BACKGROUND: Laser hair removal is associated with moderate acute pain. OBJECTIVE: To compare effectiveness of ice pack to topical lidocaine-prilocaine for pain reduction during axillary laser hair removal. METHODS: Participants were randomly assigned to receive topical anesthetic to one axilla and ice packs to the other before each of 3, monthly 810 nm diode laser sessions. The primary endpoint was participant-reported pain on the visual analog scale (VAS) immediately following and 5 minutes after laser session. Posttreatment erythema, overall edema, and perifollicular edema were assessed by 2 blinded photoraters. Skin temperatures, patient preferences, and adverse events were recorded. RESULTS: Eighty-eight of 90 (98%) planned laser treatments were delivered and randomized. Participants reported higher VAS scores immediately after laser treatment with lidocaine-prilocaine compared to ice (P = .03). Five minutes after, participants reported higher VAS scores with ice (P = .03). After 53 of the 88 treatments (60.2%), participants reported preferring ice (P = .055). No serious adverse events were reported. LIMITATIONS: All participants were Caucasian or Asian with Fitzpatrick skin type I to III and coarse dark axillary hair, which may limit generalizability. CONCLUSIONS: While pain control with ice and topical anesthesia is associated with time after treatment, the 2 modalities do not differ in terms of degree of pain reduction associated with axillary laser hair removal.

Mechanism of crescent-shaped and ring-shaped epidermal damage from laser hair removal with cryogen spray cooling.

The safety and efficacy of laser hair removal have been well established through many clinical studies and through clinical use over the past 25 years. A laser hair removal device that protects the epidermis by utilizing cryogen spray cooling (CSC) is widely used internationally. In darker skin types, post-inflammatory hyperpigmentation (PIH) can occur after laser hair removal. In particular, laser hair removal with CSC is known to cause crescent-shaped or ring-shaped PIH. In this experiment, we report a visualization of this PIH mechanism. The laser used in this experiment is a 755-nm-long-pulsed alexandrite laser. Graph paper was treated with this laser to assess for thermal damage. We investigated changes in thermal damage due to differences in laser spot size, fluence output, and laser beam angle in relation to the graph paper. When using a spot size of 18 mm, we observed that higher fluences caused crescent-shaped thermal damage on the margins of the treated graph paper. It was also confirmed that when the hand piece is not held perpendicular to the skin, the laser-treated area is expanded and the CSC range is narrowed. These factors caused the area of thermal damage to widen. This widening causes ring-shaped thermal injury, leading to PIH. We treated graph paper using a hair removal laser with CSC to investigate the mechanism of crescent or ring-shaped thermal damage. Laser treatment on graph paper is effective as a test for defects in the CSC device. Factors that cause inadequate cooling, which leads to PIH, are large spot size, high fluence, not holding the laser hand piece perpendicular to the skin, and malfunctioning of CSC device.

Severe persistent urticaria following laser hair reduction.

BACKGROUND: Laser hair reduction is a common practice that utilized light-based therapy to prevent future hair growth. Complications following laser hair reduction treatment include thermal burns, which may lead to hyper- or hypopigmentation, hair stimulation, scar, or transient erythema of treated areas. AIMS: Review reports of persistent urticaria following laser hair reduction and discuss a rarely discussed laser complication. METHODS: Pubmed literature review. RESULTS: There have been very rare reports of persistent urticaria following laser hair reduction. Similar case reports have also been described though no definitive reasoning for this reaction, nor consistent treatment has been documented. DISCUSSION: In this report, we present a patient who developed persistent urticaria with severe pruritus in the areas treated with laser hair reduction. Previous reports an association was found between allergies and post-treatment urticarial eruption, with 33/36 patients having allergies, mostly to dust mites which is similar to the patient presented. Other etiologies such as reaction to cryogen and physical urticaria are unlikely. CONCLUSION: Our report highlights a case of persistent urticaria with severe pruritus following laser hair reduction treatment, with both similarities and differences to other cases reported in the literature. While this is a rare side effect of laser hair removal, it should be monitored in patients who have a history of moderate to severe environmental allergies.

Safety and efficacy for hair removal in dark skin types III and IV with a high-powered, combined wavelength (810, 940 and 1060 nm) diode laser: A single-site pilot study.

BACKGROUND: Previous studies have demonstrated the superior efficacy of a high-power diode laser (4800 W) with a wavelength of 810 nm over others with less power and the same wavelength, while also being safe and comfortable for the patient. However, the use of this laser is limited on dark skin. OBJECTIVES: This study aims to compare the efficacy, safety, and comfort of a 4800 W diode laser (810 nm) with that of the new Blend diode laser (810 nm, 940 nm, and 1064 nm). Furthermore, the study aims to demonstrate that the Blend diode laser delivers better results on darker skin. MATERIALS AND METHODS: A 810 nm diode laser was compared with the Blend diode laser (810, 940 and 1064 nm) (Primelase, Cocoon Medical). A side-by-side comparative study was carried out over three sessions involving fourteen participants with skin types III and IV, with evaluation of the results 6 months after treatment. The study was performed at the Tennessee Clinical Research Center, Nashville, Tennessee, USA. This evaluation was based on efficacy, safety, comfort, and participant satisfaction. RESULTS: Blend diode laser treatments were performed with fluences 40% (SE = 0.04%) higher than those of the 810 nm. Besides mild-to-moderate transient discomfort during the procedure, the Blend diode laser also produced an increased pricking sensation that was 1.8 points higher on a 10-point scale (p < 0.05), due to the higher fluence used. Hair reduction was 12% higher with the Blend diode laser, with a confidence level of 70%. Moreover, participants were more satisfied with the results of the Blend diode laser than with the diode laser (50% very satisfied vs. 36%, respectively). No long-term adverse effects were observed. CONCLUSIONS: The new Blend diode laser has been shown to be more effective and satisfactory than 810 nm diode laser on dark skin types III and IV, while also being safe and comfortable for participants.