Home-based devices in dermatology: a systematic review of safety and efficacy.

There is increasing demand for home-based devices for the treatment of dermatologic conditions and cosmesis. Commercially available devices include intense pulsed light, laser diodes, radiofrequency, light-emitting diodes, and ultraviolet B phototherapy. The objective of this report is to evaluate the current evidence regarding the efficacy and safety of home-based devices for the treatment of skin conditions. A systematic search of PubMed, Embase, and Cinahl was conducted on November 9, 2020 using PRISMA guidelines. Original research articles that investigated the efficacy and safety of home-based devices for dermatologic use were included. Bibliographies were screened for additional relevant articles. Strength of evidence was graded using the Oxford Centre for Evidence-Based Medicine guidelines. Clinical recommendations were then made based on the quality of the existing literature. After review, 37 clinical trials were included-19 were randomized controlled trials, 16 were case series, and 2 were non-randomized controlled trials. Ultimately, from our analysis, we recommend the home-based use of intense pulsed light for hair removal, laser diodes for androgenic alopecia, low power radiofrequency for rhytides and wrinkles, and light-emitting diodes for acne vulgaris. Trials investigating ultraviolet B phototherapy for psoriasis revealed mixed evidence for home treatments compared to clinic treatments. All devices had favorable safety profiles with few significant adverse events. Limitations to our review include a limited number of randomized controlled trials as well as a lack of data on the long-term efficacy and safety of each device.

Innovative 1064-nm Nd:YAG Laser Significantly Improves Keratosis Pilaris, A Randomized, Double-Blind, Sham-Irradiation-Controlled Trial.

BACKGROUND AND OBJECTIVE: Keratosis pilaris (KP) is a common follicular disorder for which various topical agents and energy-based devices have been used with some efficacy. To evaluate the efficacy of a novel 1064-nm Nd:YAG laser for the reduction of skin roughness, erythema, and hyperpigmentation in KP subjects. STUDY DESIGN/MATERIALS AND METHODS: Twenty-three subjects with untreated KP on the upper outer arms participated in a randomized, single-blind fashion. One arm of each subject was divided into upper and lower parts. One part was randomized to be treated with an innovative 1064-nm Nd:YAG laser, while the other part received sham irradiation. Subjects received four consecutive treatments at 4-week intervals. Antera3D was used to measure skin roughness, erythema, and hyperpigmentation at baseline and 4 weeks after the last treatment. Moreover, clinical outcomes were also evaluated by subjects' Global Improvement Score (GIS) and subjects' satisfaction grading scores. RESULTS: Twenty-three subjects completed the study. There was statistically significant reduction of skin roughness measured by Antera3D compared with control group (P < 0.001). There were statistically significant improvements of skin roughness, erythema, hyperpigmentation, and overall appearances graded by subjects' Global Improvement Score (P < 0.001 all). Subjects' satisfaction scores were graded significantly better in treatment parts (P < 0.001). No adverse events including burning, bulla, erosion, post-inflammatory hyper/hypopigmentation, and scar formation developed in any subjects throughout the study period. CONCLUSION: This innovative 1064-nm Nd:YAG laser has proved to significantly and safely reduce skin roughness in Thai KP subjects compared with control after four sessions. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Laser Treatment of Skin of Color for Medical and Aesthetic Uses With a New 650-Microsecond Nd:YAG 1064nm Laser

Individuals with skin of color are a rapidly growing portion of the cosmetic procedures market. There are unique challenges to treating skin conditions in skin of color patients. This article and roundtable discussion focus on the use of energy-based modalities, particularly a 650-microsecond 1064nm laser that delivers energy in a collimated beam. Alone or in combination with other therapies, the 650-microsecond 1064nm laser has been used successfully to treat melasma, acne, postinflammatory hyperpigmentation, pseudofolliculitis barbae, hair removal, acne keloidalis nuchae, and aging skin in skin of color. J Drugs Dermatol. 2019;18(4 Suppl 1):s135-137.

Dose-response of human follicles during laser-based hair removal: Ex vivo photoepilation model with classification system embracing morphological and histological features.

OBJECTIVES: Photoepilation is a commonly used technology in home-use devices (HUDs) and in professional systems to remove unwanted body hair using pulses of laser or intense pulsed light (IPL). Albeit HUDs and professional systems operate at different fluences and treatment regimes, both demonstrate high hair reduction. The underlying mechanisms, however, remain unknown partly due to high divergence of the existing literature data. The objective of this study was to develop an ex vivo photoepilation model with a set of criteria evaluating response to light pulses; and to investigate dose-response behavior of hair follicles (HFs) subjected to a range of fluences. METHODS: After ex vivo treatment (single pulse, 810 nm, 1.7-26.4 J/cm2 , 4-64 ms pulse) human anagen HFs were isolated and maintained in culture for 7-10 days. Response to light was evaluated based on gross-morphology and histological examination (H&E and TUNEL stainings). RESULTS: HFs treated ex vivo demonstrated a dose-dependent response to light with five distinct classes defined by macroscopic and microscopic criteria. Fluences below 13.2 J/cm2 provoked catagen-like transition, higher fluences resulted in coagulation in HF compartments. CONCLUSION: Observed changes in the HF organ culture model were reflected by clinical efficacy. The developed photoepilation model provides an easy and fast method to predict clinical efficacy and permanency of light-based hair removal devices. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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 review of available laser and intense light source home devices: A dermatologist's perspective.

BACKGROUND: Home optical devices are becoming an increasingly popular treatment modality sought out by patients for dermatologic pathologies such as acne, hair removal and anti-aging, as these devices are a low-cost and convenient therapy choice. METHODS: An Internet search using PubMed.gov was completed with search terms, "home device dermatology," "home device acne," "home device hair" or "hair removal," and "home device aging." RESULTS: Currently, there are multiple home optical devices available on the market. These devices have been approved for the treatment of acne, scars, hair removal, and wrinkles using intense pulsed light, light-emitting diode, heat, infrared, low-level light therapy, and laser. Although studies on home devices are limited, current dermatologic literature shows that these devices are promising with significant post-treatment results as well as a high level of safety. CONCLUSIONS: Home optical devices are mostly used without medical practitioner supervision. As home devices usually deliver less energy per session than with professional treatments, it is important that consumers are given realistic expectations of post-treatment outcomes. Patients may use home devices without disclosure to their physician and it is important as healthcare professionals to be aware of the existence of these devices, how to use the devices properly (including what diseases can be treated and which skin types are considered safe for use), as well as any adverse effects that may occur. New research endeavors are being completed to explore the used of home devices for the treatment of chronic inflammatory diseases such as psoriasis.

Clinical Evaluation of Hair Removal Using an 810 nm Diode Laser With a Novel Scanning Device.

INTRODUCTION: Diode lasers are often considered as the gold standard preference for hair removal due to the deep penetration and ef- fective targeting of the hair follicle. A wide variety of diode lasers are available, which can differ in terms of their parameters (such as fluence, pulse duration, repetition rate, scanner, and cooling). OBJECTIVE: The objective of the study was to evaluate the safety and ef cacy of hair removal with an 810 nm novel scanning diode laser, up to six months after last treatment. METHODS: A scanning 810 nm diode laser was used for axillary hair removal of 14 female patients who received 3 treatments, 4-6 weeks apart. Follow-up on hair count was conducted 3 and 6 months after last treatment and compared to baseline hair count. RESULTS: No unexpected or signi cant adverse events were recorded. An average hair count reduction of 72.8% after 3 months and 67.6% 6 months after the last treatment is demonstrated. CONCLUSIONS: The examined 810 nm diode laser was proven to be safe and effective for hair removal. Results were sustained for 6 months after last treatment. Longer follow-up data are followed for further substantiation of the clinical effect. Scanning technology can provide for potentially faster and safer treatments. J Drugs Dermatol. 2016;15(11):1330-1333..

Home hair removal in all skin types with a combined radiofrequency and optical energy source device.

BACKGROUND: Home hair removal devices are available for skin types I to IV. Side effects may limit hair removal in darker-pigmented individuals. OBJECTIVE: To evaluate a home hair removal device using combined radiofrequency (RF) and intense pulsed light (IPL) energy for effectiveness and safety with all skin types (I-VI). DESIGN: Two study designs: effectiveness (treating 94 bilateral patient areas weekly seven times, with one side then receiving three additional treatments at 4-week intervals) and safety (37 patient areas treated every 2-4 days for three sessions). MEASUREMENTS: Hairs were counted 3 months after treatment for the first design and 2 months after for the second. RESULTS: In the first study design, 55% hair count reduction was achieved1 month after seven treatments to all sites. The side with no further sessions had 43% hair reduction and the side receiving ongoing treatment had 58% reduction after two further treatments. Side effects were transient and minor. In the second study, with 46% of the patients having skin types V/VI, 2 months after the procedure there was 44% hair reduction. There were no adverse effects reported. CONCLUSION: For the first time, a home hair removal device has been shown to be effective and safe in all skin types using a low-energy RF-IPL device.

Clinical and microscopic evaluation of long-term (6 months) epilation effects of the ipulse personal home-use intense pulsed light (IPL) device.

BACKGROUND: The aim of this study is to investigate the cellular mechanism of long-term hair reduction using a novel, square pulse, low-fluence home-use IPL device. METHODS: Ten subjects' axillae (Fitzpatrick III-V) were treated once weekly for four consecutive weeks in a simulated home-use trial. Treated and control site punch biopsies were taken from axillary sites for H&E staining and blinded histological examination before, immediately after and six months after the fourth treatment. The contralateral axilla served as a control. RESULTS: Histologically, four sequential weekly treatments gave a significant increase in telogen compared with anagen follicles. Six months after the fourth treatment, an 87% reduction in terminal hair count (P ≤ 0.00005) was recorded. An atypical telogen with infundibular dilatation and plugging of keratin and clumping of melanin with disintegration and/or retraction of the intraluminal hair shaft were observed. The papillae remained viable and some new anagen follicles were evident after four treatments. Vellous hairs appeared unaffected by IPL exposures. A mixed inflammatory infiltrate of lymphocytes and eosinophils around vessels of the superficial and deep dermis was sometimes present but the epidermis appeared always normal. CONCLUSION: A highly significant hair density reduction through induction of telogen followed by miniaturization similar to that achieved in professionally delivered permanent laser hair reduction appears to be the major mechanism of hair reduction using home-use IPL. IPL-induced damage to the isthmus and upper stem may inhibit or interfere with the hair regrowth process. Longer term studies are required to determine if this observed damage is clinically permanent.

Home-use devices in aesthetic dermatology.

The world of aesthetic medicine is increasingly a consumer-driven market with a wide variety of home-use devices from which the consumer can choose for treating hair removal, hair loss, acne, facial rejuvenation, and other dermatologic conditions. Where these devices fit in the physician practice and consumer routine can be confusing, as scientific studies may be weak or lacking. The specifications, price, ease-of-use, maintenance, and technology can differ greatly between devices. Thus, the physician and consumer need to define exp.

Long-pulsed Nd:YAG laser in the treatment of facial hypertrichosis during topical minoxidil therapy.

Hypertrichosis is a well-recognized adverse effect of therapy with either oral or topical minoxidil. We report a case of fronto-temporal hypertrichosis occurring in an 8-year-old girl treated for patchy alopecia areata of the frontal area of the scalp with 2% minoxidil solution. After failure of 5-months minoxidil-discontinuation, hair removal with Nd:YAG laser (1064 nm line) (Smartepil II, Deka) was tested leading to complete resolution within 2 sessions.

Dermoscopic changes in melanocytic nevi after depilation techniques.

Depilation techniques have gain popularity in the last few decades. Nowadays there are available a wide variety of lasers as well as intense pulsed light for depilation. However, little is known about the long-term effects of these procedures when melanocytic nevi are affected by them. We report the cases of three patients where we observed clinical, dermoscopic and histopathological changes secondary to laser therapy and intense pulsed light depilation, respectively. We believe that it is necessary to perform further studies to prove the absence of malignant transformation so that we will be able to set up recommendations in those patients with a personal or family history of malignant melanoma and/or dysplastic nevi.

A 12-month follow-up of hypopigmentation after laser hair removal.

INTRODUCTION: Laser hair removal is becoming an increasingly popular alternative to traditional methods such as shaving, waxing, among other methods. Semiconductor diode lasers are considered the most efficient light sources available and are especially well suited for clinical applications including hair reduction. The effectiveness of laser hair reduction depends on many variables, including the skin type of the patient. MATERIAL AND METHODS: A patient with Fitzpatrick Skin Type IV was submitted to laser hair removal of the arms with a high-power diode laser system with long pulses with a wavelength of 800 nm, a fluence of 40 J/cm(2) and a pulse width of 20 ms. A 12-month follow-up assessment was performed and included photography and questionnaire. RESULTS: Hypopigmentation was observed after a single laser hair removal section. After 6 months with the area totally covered, a gradual suntan with a sun screen lotion with an SPF of 15 was prescribed by the dermatologist. After 12 months of the initial treatment, a complete recovery of the hypopigmentation was achieved. CONCLUSION: Although a safe procedure, lasers for hair removal may be associated with adverse side effects including undesired pigment alterations. Before starting a laser hair removal treatment, patients seeking the eradication of hair should be informed that temporary, and possibly permanent, pigmentary changes may occur.

Complications in lasers, lights, and radiofrequency devices.

Lights, lasers, and radiofrequency are unique sources of energy that are increasingly utilized for therapeutic and cosmetic purposes. As the indications for these tools continue to increase and their use expands beyond physicians to aestheticians, physician-extenders, and technicians, the incidence of complications has also risen. It is imperative that operators of these tools be as familiar with the management of potential complications as they are with their usage and indications. This article serves as a review of potential complications encountered with usage of lasers, lights, and radiofrequency devices in dermatology.

New intense pulse light device with square pulse technology for hirsutism in Indian patients: a pilot study.

BACKGROUND: Intense pulse light (IPL) with square pulse technology is one of the latest hair removal technologies to be marketed in India. However, there is no literature on use of IPL in Indian skin. OBJECTIVE: A preliminary descriptive study to ascertain the efficacy of an IPL device with square pulse technology for hair removal in Indian patients. MATERIALS AND METHODS: The IFL i200 system (Cyden Ltd, Swansea, UK) was used for hair removal on 12 patients of skin type III, IV and V up to a maximum of six sessions. Hair removal efficacy (HRE) was calculated and photographs taken after each session. RESULTS: Treatment was done for 12 patients. Mean HRE was 69.6%; 83% were satisfied with the procedure; 66% had excellent results; 16% had good results. No permanent adverse effects were seen. CONCLUSION: With standard precautions, IPL is a safe and effective tool for hair removal in Indian patients. Further studies to compare square pulse technology with traditional IPL systems and lasers are required.

Laser and intense pulsed light hair removal technologies: from professional to home use.

Light-based hair removal (LHR) is one of the fastest growing, nonsurgical aesthetic cosmetic procedures in the United States and Europe. A variety of light sources including lasers, e.g. alexandrite laser (755 nm), pulsed diode lasers (800, 810 nm), Nd:YAG laser (1064 nm) and broad-spectrum intense pulsed light (IPL, 590-1200 nm), are available and used widely for such procedures in dermatological/clinical settings under proper supervision. Patient selection and appropriate fluence settings are managed by professionals to maximize efficacy while minimizing adverse events. In the past 5 years, LHR devices have been sold directly to consumers for treatment in the home. In this review, we outline the principles underlying laser and IPL technologies and undertake an evidence-based assessment of the short- and long-term efficacy of the different devices available to the practising dermatologist and discuss the efficacy and human safety implications of home-use devices.

Home-use laser and light devices for the skin: an update.

Over the past several years, a number of home-use laser and light skin devices have been introduced for various indications, including photorejuvenation, hair growth, hair removal and acne treatment. Although these devices allow for privacy and a significant cost advantage, they are typically underpowered and afford lower efficacy than their in-office counterparts. A number of these devices have recently received FDA clearance. Although large clinical trials are lacking, dermatologists should familiarize themselves with the various options to help patients assess their clinical value.

Laser therapy in black skin.

This article provides a systematic overview of laser, light, and other energy devices for patients of African descent. It also reviews complications in skin of color and some treatment options for these adverse events.