The diverse application of laser hair removal therapy: a tertiary laser unit's experience with less common indications and a literature overview.

We describe the diversity of indications for laser hair removal (LHR) therapy and compare our experience with the literature. Patients' case notes referred to the Birmingham Regional Skin Laser Centre between 2003 and 2011 for laser hair removal, with indications other than hirsutism, were reviewed retrospectively. Thirty-one treated patients with the following indications were identified: hair-bearing skin grafts/flaps, intra-oral hair-bearing flap, Becker's naevus, localised nevoid hypertrichosis, peristomal hair-bearing skin, scrotal skin prior to vaginoplasty in male-to-female (MTF) gender reassignment, pilonidal sinus disease (PSD), pseudofolliculitis barbae (PFB) and hidradenitis suppurativa (HS). Seven patients with the following indications have been reported before: intra-oral hair-bearing graft, naevoid hypertrichosis and peristomal hair-bearing skin. A clinical review of the evidence available for each indication is provided. Our experience and that in the published literature suggest that LHR is a safe, well-tolerated and effective treatment modality for the indications we report, leading to significant symptom and functional improvement with high patient satisfaction. LHR appears effective in the treatment of chronic inflammatory conditions such as PSD, PFB and HS, particularly at an early disease stage. We aim to increase awareness of the diversity of laser hair removal indications and add evidence to the medical literature of the wide range of indications for this useful treatment modality.

Best practice options for hair removal in patients with unwanted facial hair using combination therapy with laser: guidelines drawn up by an expert working group.

Hirsutism is a common disorder affecting between 5 and 15% of the population. One of the most devastating consequences of hirsutism is the presence of unwanted facial hair. Treatment of hirsutism involves a two-pronged approach: treating the underlying cause and reduction of visible hair. Laser hair removal is one of the most effective options for reducing visible hair, however, it may not be wholly effective in all patients and combination therapy may need to be considered. Pharmacological therapy is often used in combination with mechanical hair removal due to the time needed for the drug treatment to demonstrate visible results. Clinical data investigating the use of laser treatment in combination with other treatments has focused on laser with topical eflornithine. The expert working group reviews existing data and provides guidance on the use of eflornithine in combination with laser for resistant hirsutism.

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.

Two different mutations in the same codon of a type II hair keratin (hHb6) in patients with monilethrix.

Monilethrix is an autosomal dominant hair disorder characterized by a beaded appearance of the hair due to periodic thinning of the shaft. The phenotype shows variable penetrance and results in hair fragility and patchy dystrophic alopecia. Mutations of the helix-encoding region in two hair-specific keratins (hHb1 and hHb6) have been identified. We have now investigated two unrelated monilethrix patients and identified two different novel heterozygous point mutations of the same codon in exon 7 of the hHb6 gene. Dystrophic hair samples obtained from both patients showed the typical beaded appearance by scanning electron microscopy. Both mutations affected the first base of codon 402 (glutamic acid). In patient A, a G to C transition occurred causing a glutamine substitution (GAG to CAG: E402Q) whereas in patient B, the transition was G to A yielding a lysine substitution (GAG to AAG: E402K). The sequence of the 1A helical regions of hHb1 and hHb6 as well as the 2B helical region of hHb1, were normal. Unaffected relatives did not have the hHb6 mutation and this codon was found to be highly conserved showing no alteration in the normal population (100 alleles examined). Both mutations disrupted a Taq I restriction site and restriction fragment length polymorphism analysis showed that a diagnostic 361 bp fragment could confirm the mutation. Thus, two new point mutations of the hair-specific keratin gene hHb6 have been identified in this genetic disease.

Patients' knowledge of psoriasis: pilot study.

A brief questionnaire was constructed to sample patients' factual knowledge of the nature of psoriasis. The study demonstrated that many patients with psoriasis have gaps in their knowledge of the disease or misconceptions that could be obstacles to effective treatment and disease prevention. The results of the questionnaire study are discussed as well as the need for patients to be aware of factors to improve self-care and extrinsic conditions that can exacerbate this disease.

The role of psychoneuroimmunology in the pathogenesis of psoriasis.

Although it is well known that stress can trigger and exacerbate psoriasis, the exact mechanism is unknown. An explanation is presented based on recent findings in psychoneuroimmunology. The number of cutaneous sensory nerves known to release neuropeptides, such as substance P, is increased in patients with psoriasis. Preliminary data indicate altered concentrations in psoriatic lesions of the same neuropeptides known to be altered in the brain during stress. An anatomical pathway is suggested to explain how descending information from the brain could cause release of neuropeptides in the skin, which would then induce psoriasis. Biochemical and clinical evidence is presented to support the relationship between stress and psoriasis.

Recent advances in the use of lasers In dermatology.

A guide to laser treatment of port wine stains, tattoos and cutaneous pigmented disorders.

Letters.

COMPARING DRESSINGS FOR DIABETIC FOOT ULCERS HYDROGEL AND NAPPY RASH ADVANCES IN THE USE OF LASERS IN DERMATOLOGY.

From the Journals.

Topical cytokines and wound healing A digest and review of wound care issues in other journals Operating theatre practices and wound care Civilian gunshot wounds Wound treatments: old or new? Lasers in surgery.

Treatment of vascular naevi in children.

This article will summarize the treatment options available for the two commonest vascular birthmarks of childhood: port wine stains and capillary haemangiomas. The treatment of port wine stains is primarily cosmetic and performed with lasers. The treatment of capillary haemangiomas is needed for both cosmetic and medical reasons and can include lasers, corticosteroids, interferons and surgery.

Laser treatment of pigmented lesions in clinical practice: a retrospective case series and patient satisfaction survey.

Lasers are frequently used to treat pigmented skin lesions; however, there is little published data from routine clinical practice. We performed a retrospective review of patients treated between January 2003 and January 2004 to describe the patients, methods used and the clinical outcome. The long-term result was determined by a patient questionnaire. In total, 67 patients with 76 pigmented lesions were treated (22 males and 45 females, mean age 22 years); 27% had Fitzpatrick skin types IV-VI. The Q-switched Nd:YAG, and erbium:YAG lasers were used in 75% and 24% of cases, respectively, with an average of 5.4 treatments/patient. The physician-rated outcome at the end of treatment was 'very positive' in 45% and 'mostly positive' in 30% of cases. The patient-rated outcome at an average of 21 months post-treatment was 'excellent' in 29.5%, 'good' in 25%, and 'fair' in 22.7% of the 44 cases. About 50% of patients with the three most common lesions (congenital naevi, other/unspecified naevi and naevus of Ota) achieved good or excellent long-term results.

Evaluation of the treatment of venous lakes with the 595-nm pulsed-dye laser: a case series.

Venous lakes (VLs) are common benign venous ectasias in the upper dermis. They are treated to improve cosmesis and occasionally to prevent bleeding. Numerous methods have been used, such as cryotherapy, infrared coagulation and various types of lasers. They are variable in their success and all can be complicated by scarring. We report our experiences of using the 595 nm pulsed-dye laser (PDL), which has not been previously described. Eight patients were treated but sufficient resolution was achieved in only three patients. The limited success with this laser could be attributed to insufficient thermal energy being generated to close all the blood vessels permanently. A large prospective study would provide further data regarding the efficacy of the PDL. The use of compression and longer pulse durations may improve the efficacy of the 595 nm PDL to treat VLs.

The importance of KMR completion for dermatology income in secondary care in the UK.

BACKGROUND: In the UK, a Korner Medical Record (KMR) document is completed for each inpatient discharged from hospital. The number and type of medical conditions entered onto this record are used to determine the income the department will receive for that individual patient. AIMS: We set out to audit the accuracy of the KMR documentation of our dermatology ward, and to assess what impact improving these records would have on the department's income. The audit standard was that KMRs should be completed accurately and contain all of the relevant information. METHODS: KMRs from May 2005, which had been completed initially by the ward clerk, and later by the junior medical staff, were reviewed. They were then completed by the main auditor, who had received training in KMR completion from the coding department. All three sets of KMRs were reviewed by the coding officer, and their respective income calculated. RESULTS: In total, 20 patients were discharged from the dermatology ward during April 2005. The main diagnosis given for two patients was initially incorrect, and in another eight cases it could have been more accurate than was originally documented. The total number of comorbid or 'secondary' diagnoses (for all 20 patients) reported by the ward clerk was 5. Junior staff added a further 36 secondary diagnoses. The main auditor identified an additional 35 secondary diagnoses. In total, an extra pound 9211 would have been paid to the department if KMRs had been completed by the main auditor rather than the ward clerk. On an annual basis, a potential pound 110,532 would remain unclaimed if KMR completion continued to be performed by the ward clerk. CONCLUSIONS: This audit shows that KMR completion is inadequate when performed by a nonmedical practitioner. Training of medical staff in KMR completion by the coding department also significantly increases the accuracy and completeness of documentation. Dermatologists of all grades need to be aware of the importance and process of KMR completion, and routine training of medical staff by their coding department in KMR completion is recommended.

Er:YAG laser resurfacing for inoperable medium-sized facial congenital melanocytic naevi in children.

Congenital melanocytic naevi (CMN) can cause significant psychosocial morbidity, especially if they are in visually exposed areas. The preferred treatment is surgical excision, though not all lesions are amenable to this because anatomical location may preclude aesthetic and functional reconstruction. Three children with inoperable facial CMN were treated with Er:YAG resurfacing under general anaesthetic. Two children were Fitzpatrick skin type II, and one child was skin type VI. Treatment was performed at 4-9-monthly intervals. The procedure achieved significant lightening and thinning in all three cases, without scarring or dyspigmentation. One child developed herpes simplex infection in the treated area on one occasion, which was managed with oral aciclovir, and did not lead to scarring or preclude further treatment. We conclude that Er:YAG laser resurfacing is effective for CMN, even in darker skin types. The incidence of side-effects is low, although repeated treatment is necessary.

Incidence of acneform reactions after laser hair removal.

There have been several studies published on the side effects of laser hair removal, but none specifically looked at acneform reactions. The aim of this study is to obtain an accurate assessment of the incidence of acneform reactions after laser hair removal in relation to skin type, laser type, site of treatment, polycystic ovarian syndrome history (PCOS), age, and sex of the patient. This is a multi-centre prospective study of patients presenting for laser hair removal. Data were gathered using a questionnaire completed by the staff who performed the treatment. The incidence of acneform reactions was 6%. The following variables showed a statistically significant effect on the percentage of patients with reactions: age, with younger patients more likely to develop lesions; those treated with the Nd:YAG laser type were more likely to develop lesions than those treated with the alexandrite; and the Fitzpatrick skin type V showed the highest incidence of acneform lesions, followed by skin types II and IV. History of PCOS, number of prior treatments, use of aloe vera cooling gel, and the sex of the patient had no apparent effect on the incidence of acneform lesions. Acneform reactions are relatively common after laser hair removal; however, in the majority of cases, the severity of the reaction was mild and lasted for a short duration.