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.

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 Traditional methods of hair removal have been replaced by lasers. The aim of the study was to observe the effect of diode laser in hirsutism patient with normal and deranged dehydroepiandrosterone sulfate (DHEAS) and dihydrotestosterone (DHT) level. Fifty patients of facial hirsutism with skin type IV and V were enrolled. Eighteen patients with deranged DHEAS and DHT 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. 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. 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 and DHT level.

Comparison of patient satisfaction with diode laser treatment of female hirsutism: low fluence or high fluence?

The optimal fluence for treating hirsutism with the diode laser has not been elucidated. The aim of this study is to evaluate and compare the satisfaction and side effects of patients who have been treated with two diode laser therapy techniques: high-fluence and low-fluence. In this cross-sectional study, the medical records of 182 patients referred to Yazd Laser center were collected. Various side effects of laser therapy were assessed, and the satisfaction rate of the patients was evaluated at three points: after the first session, at the end of the treatment course, and six months after the end of the treatment. The satisfaction level after the first session of the laser treatment was higher with the low-fluence technique (P-value<0.001). The satisfaction level at the end of treatment was the same in the two groups (P-value = 0.394). However, six months after the treatment, satisfaction level was significantly higher with the low-fluence technique (P-value = 0.005). The rate of complications, such as burn and pain, was higher in the high-fluence group, while the number of treatment sessions was lower with the high-fluence technique. The low-fluence method of laser therapy has fewer complications associated with greater patient satisfaction.

810 nm diode laser for hair reduction with Chill-tip technology: prospective observational analysis of 55 patients of Fitzpatrick skin types III, IV,V.

Background: Various light based technologies like Diode, long pulsed Nd:Yag and Intense Pulsed Light are used commonly for long-term hair reduction. The commonest indication is hirsutism.Aim: 1. To evaluate efficacy and safety of 810 nm Diode laser in Fitzpatrick skin types III, IV and V.2. To assess percentage of cases on the basis of indications, average number of sessions, fluence required, the long-term results and complications using diode laser in darker skin types.Methods: A prospective observational study of 55 consecutive patients who came for laser hair reduction by 810 nm Light Sheer Diode laser with Chill tip technology was carried out. The sessions were conducted at an interval of 4-6 weeks and the patients were followed up over a period of 2 years. Data was analyzed using software SPSS (Statistical Package for Social Science. Ver.12, Inc. Chicago, USA).Results: Fifty-five patients (51 females and 4 males) were studied. 67.3% (n = 37) had skin type IV. The most common area treated was chin (n = 23). The average growth reduction of terminal hair at the end of three sessions was 61.25%. Only 8% (n = 4) had short-term side effects.Conclusion: Diode laser is highly effective for long-term hair reduction of terminal hair growth in Fitzpatrick skin type III, IV and V with no permanent side effects.Abbreviations: LHR (Laser Hair Reduction).

Laser-assisted hair removal for facial hirsutism in women: A review of evidence.

Poly cystic ovarian syndrome (PCOS) has been described as the common diagnosis for hirsutism in women. Facial hirsutism is by far the most distressing symptom of hyperandrogenism in women with PCOS. A statistically significant improvement in psychological well-being has been reported in patients with PCOS allocated for laser-assisted hair removal. The theory of selective photothermolysis has revolutionized laser hair removal in that it is effective and safe, when operated by sufficiently trained and experienced professionals. Long-pulsed ruby (694 nm), long-pulsed alexandrite (755 nm), diode (800-980 nm), and long-pulsed Nd:YAG (1064 nm) are commercially available laser devices for hair removal most widely studied. This article will introduce the fundamentals and mechanism of action of lasers in hair removal, in a contemporary literature review looking at medium to long term efficacy and safety profiles of various laser hair removal modalities most widely commercially available to date.

A randomized clinical trial on the comparison between hair shaving and snipping prior to laser hair removal sessions in women suffering from hirsutism.

BACKGROUND AND OBJECTIVES: Hirsutism or excess hair growth is a common dermatological problem in females, affecting up to 10% of females worldwide. We aimed this study to compare the two hair-shortening methods shaving vs. snipping among hirsute women regarding the outcome of the therapy and also the paradoxical hypertrichosis phenomenon (terminal hair regrowth) 6 months after the final therapy session. MATERIALS AND METHODS: In this study, 129 premenopausal women affected by hirsutism were randomly divided into two study groups according to hair-shortening method: shaving as group A (66 patients) and hair shortening by scissor as group B (63 patients). Each patient received six alexandrite laser therapy sessions every month for six consecutive months. Chin hairs in a 5 × 5 cm2 zone were counted, and the paradoxical hair regrowth was evaluated four times during the study: once at baseline, once before the third session, once before the sixth session, and once 6 months after the last laser session. RESULTS: Before the third session, the counts were 15.06 ± 5.20 in group A and 13.07 ± 4.44 in group B (P = 0.022); both counts were meaningfully less than the baseline count (P < 0.001). The counts before the sixth session were 2.80 ± 1.16 in group A and 2.71 ± 1.12 in group B (P = 0.673); the counts were significantly lower than the previous session (P < 0.001). Six months after the last laser session, the counts were 11.27 ± 9.30 in group A and 8.15 ± 3.12 in group B (P = 0.012). Paradoxical hypertrichosis was observed in three patients of group A vs. no patients in group B. CONCLUSION: We found that alexandrite laser therapy is really effective for treating hirsutism. Both shaving and using a scissor for hair shortening showed similar short-term results, but in one-year follow-up, paradoxical hypertrichosis was only observed in shaving group and also a lower hair count was observed in the snipping group.

Phototherapy in cosmetic dermatology.

Light therapy has been incorporated into the art of healing and cosmesis for thousands of years and currently has found utility in many areas of medicine. Various modalities of cosmetic phototherapy are detailed, as well as the indications and mechanism of action for each modality. These modalities can be used to treat many common cosmetic conditions, including acne vulgaris, solar lentigo, and melasma. Phototherapy is considered a safe and effective option in the treatment of many of these disorders.

Trichoscopic changes in hair during treatment of hirsutism with 1064-nm neodymium:yttrium-aluminum-garnet laser.

BACKGROUND: Laser hair removal has become an accepted form of long-term hair reduction and is now one of the most common dermatologic procedures. Trichoscan is a validated method of assessing hair length, thickness, and density and growth rate using dermoscopy. OBJECTIVE: The study aimed to evaluate the trichoscopic changes during treatment of hirsutism with 1064-nm neodymium:yttrium-aluminum-garnet laser. METHODS: Seventy patients with idiopathic facial hirsutism referring to the laser centers of Al-Azhar University hospital (Asyut and Cairo) between December 2012 and October 2014 were enrolled in this open-label, multicentric study. All participants received six sessions of 1064-nm Nd:YAG laser at 4-week intervals. Mean hair density/cm(2) , percentage of terminal/vellus hair ratio, and hair thickness (mm) were assessed at baseline and 1 month after each session for six sessions using trichoscan. RESULTS: Seventy female patients completed the study protocol. At the final visit, mean hair density, terminal/vellus hair ratio, and hair thickness were significantly decreased from baseline (73.7 + 20.6, 72.5 + 14.7, 0.095 + 0.02, respectively) to (19.4 + 5.6, 21.3 + 5.2, 0.02 ± 0.007, respectively) (P < 0.05 for each). CONCLUSION: One thousand and sixty-four-nm Nd:YAG laser is an effective and safe method in the reduction of unwanted facial hair. Trichoscan is an easy and more accurate method in monitoring the treatment of hair disorders.

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

BACKGROUND: Undesirable hair growth presents a significant problem for many patients. Photoepilation has become a very popular procedure in esthetic and cosmetic practice. Among the systems used are the long-pulsed alexandrite laser (755 nm) (ALX) and intense pulsed light (IPL). OBJECTIVE: To compare the safety and efficacy of long-pulsed ALX and IPL for hair removal. PATIENTS AND METHODS: This comparative study was carried out in the outpatient Department of Dermatology and Venereology, Al-Sadir Teaching Hospital, Al Najaf City during the period from June 2009 to July 2010. Thirty-five patients were included; thirty of them completed the study. They received six treatment sessions with the ALX on the left side of the face and IPL on the right side of face with 4-week intervals between sessions. Response to treatment on both sides of the face was assessed at 1, 3, and 6 treatment sessions. Hair-free intervals and patient's satisfaction were recorded in each visit. RESULTS: After six treatment sessions, IPL-treated sides showed longer median hair-free intervals compared with ALX-treated sides. Reduction in hair counts was significantly larger on the IPL compared with that on the ALX-treated sides at 1, 3, and 6 sessions. Three patients (10%) developed postinflammatory hyperpigmentation, one of them on the left side and the others on the right side. It was more severe on the right side and both the patients were of skin type IV. Slight stinging and burning sensation at time of the treatment were recorded in all patients. All reported side effects were transient and tolerated by the patients except postinflammatory hyperpigmentation which persisted and was decreasing gradually toward the end of the study. CONCLUSIONS: The results of this study suggested that IPL is more effective in reducing excessive facial hair growth, with longer hair-free intervals and greater patient satisfaction than the ALX.

Hormonal profile and efficacy of long pulse Nd-YAG laser in treatment of hirsutism.

BACKGROUND: Hormones, particularly androgens play a vital role in hair growth, differentiation and distribution. Hirsutism is a common entity among Nepalese population with skin types III, IV and V. Long pulsed lasers are commonly used for hair removal. METHODS: This is a prospective analytical study done in Dhulikhel Hospital Kathmandu University Hospital, Kavre, Nepal from November 2010 to November 2011. Patients were first subjected to hormonal evaluation. Androgens, their tropic hormones, insulin resistance markers and endocrine components were measured and compared. Subjects were then categorized into two groups according to androgen levels: group A (n=30) with significantly high androgen (total testosterone and dehydroepiandrosterone sulfate) or elevated luteinizing hormone: follicle stimulating hormone ratio, consistent with Polycystic Ovarian Syndrome (PCOS) and group B (n=30). Adrenal tumour was ruled out in all patients. All patients received long pulse Nd-YAG laser (50J/cm²; 50 msec pulse duration) therapy at four weeks interval to achieve at least 50% hair reduction. RESULTS: Among group A patients, average 8.1 treatment sessions were required for substantial hair reduction, whereas, average 5.7 sessions produced similar results in group B patients (p-value <0.05). CONCLUSIONS: Patients with high androgen level and elevated LH: FSH ratio requires more treatment sessions for hair removal with long pulsed ND-YAG laser than patients with normal or low hormone level.

A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism.

OBJECTIVE: We sought to determine whether topical finasteride can enhance the efficacy of intense pulsed light hair removal. MATERIALS AND METHODS: An intense pulsed light (IPL) treatment with radiofrequency (RF) was performed every four weeks, resulting in up to three sessions, and again at the end of the study - 6 months after the start of the experiment. Each patient also applied either finasteride or placebo solution twice daily to each side of the chin in a double-blinded manner. RESULTS: A total of 77 patients were included in the study. Mean hair density before treatment in finasteride side of the patient's chin was 19.7 ± 11.7 and in placebo side was 19.1 ± 11.3. After three sessions of IPL + RF treatment, combined with twice daily application of finasteride and placebo solutions, at the end of 6-month period mean hair density of 8 ± 6.3 and 9 ± 5.6 was achieved in finasteride and placebo side respectively. Statistically significant difference was found between finasteride and placebo solution. CONCLUSIONS: We have demonstrated that the addition of finasteride solution to IPL + RF hair removal may result in a more reduction of unwanted facial hair in women when the combination is used for up to 6 months.

Hair removal in hirsute women with normal testosterone levels: a randomized controlled trial of long-pulsed diode laser vs. intense pulsed light.

BACKGROUND: Hirsutism is a common disorder in women of reproductive age, and androgen disturbances may aggravate the condition. Limited evidence exists regarding efficacy of hair removal in this specific population and no data are available for patients with verified normal testosterone levels. OBJECTIVES: To compare efficacy and safety of intense pulsed light (IPL) vs. long-pulsed diode laser (LPDL) in a well-defined group of hirsute women with normal testosterone levels. METHODS: Thirty-one hirsute women received six allocated split-face treatments with IPL (525-1200 nm; Palomar Starlux IPL system) and LPDL (810 nm; Asclepion MeDioStar XT diode laser). Testosterone levels were measured three times during the study period. Patients with intrinsically normal or medically normalized testosterone levels throughout the study were included in efficacy assessments (n = 23). Endpoints were reduction in hair counts assessed by blinded photoevaluations at baseline and 1, 3 and 6 months after final treatment, patient-evaluated reduction in hairiness, patient satisfaction, treatment-related pain and adverse effects. RESULTS: IPL and LPDL reduced hair counts significantly, with median reductions from baseline of 77%, 53% and 40% for IPL and 68%, 60% and 34% for LDPL at 1, 3 and 6 months, respectively. At 6 months follow-up, there was no significant difference between treatments in terms of hair reduction (P = 0·427), patient assessment of hairiness (P = 0·250) and patient satisfaction (P = 0·125). Pain scores were consistently higher for IPL [median 6, interquartile range (IQR) 4-7] than LPDL (median 3, IQR 2-5) (P < 0·001). CONCLUSION: Hirsute women with normal or medically normalized testosterone levels responded equally well to IPL and LPDL treatments of facial hairiness, but the efficacy declined over 6 months.

Unwanted facial hair removal with laser treatment improves quality of life of patients.

BACKGROUND: Unwanted facial hair can have adverse psychological effects on women and reduce their quality of life. OBJECTIVE: To assess the effects of unwanted facial hair removal with laser on improving quality of life. METHODS: In this study, 70 patients treated for unwanted facial hair by laser were assessed by Dermatology Life Quality Index (DLQI) questionnaire on admission and 3 months later after three sessions of laser treatment. RESULTS: The DLQI score before treatment was 9.42 +/- 5.99, which was reduced to 3.12 +/- 3.40 after laser treatment (p <0.05). CONCLUSION: Unwanted facial hair removal with laser can improve the quality of life of patients.

Hair removal with the long-pulse alexandrite and long-pulse Nd:YAG lasers is safe and well tolerated in children.

BACKGROUND: Children with excessive hair may have severe psychological consequences. Laser hair removal in adults is known to be safe and well tolerated, but this is less well established in children. OBJECTIVE: To describe our experience with laser hair removal in children, and to investigate the safety and tolerability of this procedure in children. METHODS: The case records of 24 children aged < 16 years, who had received a minimum of three treatments for hair removal were analysed retrospectively. For patients with Fitzpatrick skin phototype II-IV, the lasers used were a long-pulse alexandrite (755 nm) with either continuous chilled-air cooling at fluences of 16-27 J/cm(2) or a long-pulse alexandrite with cryogen cooling at fluences of 16-32 J/cm(2). For patients with Fitzpatrick skin phototype IV-VI, lasers used were a long-pulse Nd:YAG (1064 nm) with a chilled contact sapphire tip at fluences of 20-35 J/cm(2) or a long-pulse Nd:YAG with cryogen cooling at fluences of 16-26 J/cm(2). RESULTS: Mean age at first treatment was 12.3 years. Diagnoses were constitutional hirsutism (14 patients), polycystic ovarian syndrome (five), congenital melanocytic naevus (two), generalized hypertrichosis (two) and naevoid hypertrichosis (one). One patient required a general anaesthetic, eight required topical anaesthetic cream, and 15 did not require any form of anaesthesia. Intolerable discomfort requiring adjustment in fluence was the only recorded side-effect, affecting two cases. There were no incidences of blistering, infection, dyspigmentation or scarring. CONCLUSION: When administered appropriately, laser hair removal is safe and well tolerated in children aged < 16 years.

Intense pulsed light photoepilation in hirsute women: the role of obesity.

Intense pulsed light (IPL) has shown diverse results in hair clearance related to treatment protocols or skin phototype. Hirsutism may be due to endocrine disease, as in polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia (CAH), both of which conditions may be associated with obesity. Obesity complicates the metabolic pattern, particularly in terms of insulin resistance, which may worsen the clinical condition of hirsutism. This study evaluated the role of obesity in photoepilation, comparing the clinical efficacy, long-term hair reduction and patient satisfaction in 40 hirsute women with PCOS or CAH, either obese (n = 20) or of normal weight (n = 20). The IPL settings were the same for both groups, but the number of sessions varied according to the clinical results. Obese patients showed a statistically significant severity of initial hirsutism if compared to the non-obese population and, for this reason, required more sessions to achieve hair reduction. The results were maintained at the 2-year follow-up examination, with a high satisfaction rate in both groups.

Burning, paradoxical hypertrichosis, leukotrichia and folliculitis are four major complications of intense pulsed light hair removal therapy.

BACKGROUND: Lasers and intense pulsed light (IPL) are now used worldwide for prolonged photo-epilation. OBJECTIVE: To study the side effects of IPL hair removal therapy among 2541 female hirsute patients as the largest series reported so far in the literature. METHODS: The first series of 1000 patients were treated by the Lumina IPL system. (Lynton Lasers, UK). The second series of 1541 patients were treated by Vasculight-SR, a multi-functional laser and IPL system (Lumenis, Inc., USA). The fluences used for Lumina varied between 16 and 30 J/cm2. The parameters used for Vasculight-SR were as follows: fluences ranged from 33 to 42 J/cm2; pulse duration was 3-5 ms, and pulse delay was 20-80 ms. The pulse mode was either double or triple. The parameters were chosen according to the patients' Fitzpatrick skin types and tolerance. The cut-off filters frequently used were 695, 755, 645 and 615 nm in descending order of their frequencies. Patients were treated every 4-6 weeks and for eight sessions or more. All patients were followed for up to 20 months. RESULTS: Series 1 - burning and its sequelae presented as post-inflammatory hyperpigmentation (PIH), post-inflammatory hypopigmentation (PIHPO), bulla and erosion, and finally scar formation in 75, 10, 64 and one case, respectively. Leukotrichia, folliculitis, and paradoxical hypertrichosis were recorded in 40, 35, and 12 more cases, respectively. Series 2 - PIH and PIHPO were recorded in 28 and four patients. Erosion and crust formation were recorded in 28 patients. Paradoxical effect, leukotrichia and acne formation were seen in 79, 27 and 19 cases, respectively. CONCLUSION: Burning and its sequellae, leukotrichia, paradoxical hypertrichosis and folliculitis are four major side effects of IPL hair removal therapy in our study.

Excess salt and pepper hair treated with a combination of laser hair removal and topical eflornithine HCl.

A common problem among aging women, salt and pepper facial hair poses a significant psychosocial impact as well as a challenge for treatment. Various laser therapies or topical eflornithine HCl 13.9% cream are commonly used to reduce the rate of hair growth. We report a case of a woman with salt and pepper hair in the beard distribution. A combination of laser hair removal with concurrent use of topical eflornithine was used in the treatment.

[Effectiveness and safety of long-pulsed Alexandrite laser for hair removal in 1702 patients].

OBJECTIVE: To evaluate the effectiveness and safety of long-pulsed Alexandrite laser for hair removal. METHODS: Hair removal was performed in 1702 hirsute patients with long-pulsed Alexandrite laser. Among them 1603 patients received two or more operations. RESULTS: In patients who received 2, 3, 4, 5, and > or =6 operations, the effectiveness rates were 9.79%, 18.33%, 29.10%, 37.64%, and 82.68%, respectively. The number of operation correlated with the effectiveness, and > or =6 operations resulted in superior outcomes. Pigmentation occurred in 0.94% of the patients (16/1702). CONCLUSION: The long-pulsed Alexandrite laser system is effective and safe in removing hair.

[Free versus non-free treatments with laser and intense pulsed light in dermatology: distinguishing medical laser treatments to be provided free of charge from cosmetic self-payment treatments]. / Dermatologisk behandling med laser og intenst pulserende lys: afgraensning af medicinske vederlagsfri versus kosmetiske ikkevederlagsfri behandlinger.

Lasers and light sources are increasingly used in dermatology. Due to the limited financial resources of the public health care system, the Danish Dermatological Society has developed recommendations for distinguishing medical laser treatments to be provided free of charge from cosmetic self-payment treatments. Several considerations underlie the recommendations: present legislation; the diagnosis, etiology, severity, and anatomical location of the disease; and the availability of evidence-based treatments. It is suggested that the recommendations constitute the basis for referring patients to dermatological treatment involving laser and intense pulsed light in Denmark.

Hair growth induced by diode laser treatment.

BACKGROUND: Although hair reduction by long-pulsed red and infrared lasers and light sources is generally quite effective, paradoxical hair growth has rarely been observed following treatment. OBJECTIVE: To report a case of thick hair growth following 810 nm diode laser treatment and its subsequent treatment. METHODS. A 24-year-old man who had previously had laser hair reduction on his posterior neck was treated to a test area on his upper back. RESULTS: Thick terminal hair developed in the treated area subsequent to laser treatment. Further treatment of this area removed the terminal hair but resulted in terminal hair growth in an annular distribution surrounding the treatment site. CONCLUSIONS: Diode laser treatment rarely stimulates terminal hair growth. This phenomenon should be studied to better understand hair growth cycles and to help develop more effective treatments for hair loss and hair growth.

A randomized controlled trial of laser treatment among hirsute women with polycystic ovary syndrome.

BACKGROUND: Facial hirsutism is one of the characteristic features of polycystic ovary syndrome (PCOS), and this can lead to high levels of depression and anxiety. OBJECTIVES: To evaluate the impact of laser treatment on the severity of facial hirsutism and on psychological morbidity in women with PCOS. METHODS: A randomized controlled trial of five high-fluence treatments (intervention) vs. five low-fluence treatments (control) was performed over 6 months in a National Health Service teaching hospital. Subjects were 88 women with facial hirsutism due to PCOS recruited from hospital outpatient clinics and a patient support group in 2001-2002. The main outcomes were self-reported severity of facial hair (measured on a scale of 1-10), depression, anxiety (measured on the Hospital Anxiety and Depression Scale) and quality of life (measured on the WHOQOL-BREF). RESULTS: Self-reported severity of facial hair in the intervention group (n = 51) fell from 7.3 to 3.6 over the 6-month study period; for the control group (n = 37) the corresponding scores were 7.1 and 6.1. The change was significantly greater in the intervention group [ancova F((1,83)) = 24.5, P < 0.05]. Self-reported time spent on hair removal declined from 112 to 21 min per week in the intervention group and from 92 to 56 min in the control group [F((1,80)) = 10.2, P