Care of Congenital Melanocytic Nevi in Newborns and Infants: Review and Management Recommendations.

A pediatric dermatology expert working group performed a narrative review to describe care related to congenital melanocytic nevi (CMN) in neonates and infants. There are no published guidelines for most aspects of care, including routine skin care and visit intervals. Few guidelines exist for surgical management; newer recommendations favor conservative practice. Emerging evidence contributes to recommendations for screening MRI to evaluate for neural melanosis and related central nervous system complications, however, more research is needed. Risk for melanoma is generally low, but those with large, giant, or multiple CMN have a higher risk. Multidisciplinary care, with a focus on family and patient preferences, is of paramount importance. Without standardized screening and management guidelines, questions abound regarding appropriate physical examination intervals, potential treatment including full or partial excision, timing and frequency of imaging, melanoma risk, and assessment for neural melanosis. This review highlights the current state of knowledge concerning care of patients with CMN, reveals gaps in the literature surrounding skin care, and provides management recommendations. We additionally discuss cutaneous complications of CMN, such as pruritus, hypertrichosis, and wound healing. Resources and references for families and providers can help patients navigate this sometimes challenging diagnosis. Finally, we contribute expert care recommendations to the current body of literature as a foundation for the development of future, more comprehensive care guidelines.

Paradoxical Hypertrichosis Associated with Laser and Light Therapy for Hair Removal: A Systematic Review and Meta-analysis.

BACKGROUND: Paradoxical hypertrichosis (PH) is an uncommon, poorly understood adverse effect associated with laser or intense pulsed light treatment for hair removal. OBJECTIVE: The objective of this study was to conduct a systematic review and meta-analysis to determine PH prevalence and associated risk factors. METHODS: We conducted a systematic review and meta-analysis of studies evaluating hair removal with lasers or intense pulsed light. Primary outcome was PH prevalence. Meta-regression and subgroup analysis were used to investigate associations among treatment modality, patients' characteristics, and PH. RESULTS: Included were 9733 patients in two randomized controlled trials and 20 cohort studies (three prospective and 17 retrospective). Pooled PH prevalence was 3% (95% confidence interval 1-6; I2 = 97%). Paradoxical hypertrichosis was associated with a face or neck anatomic location, and occurred in only 0.08% of non-facial/neck cases. Treatment modality and interval between treatments had no effect on the PH rate. There were insufficient data to determine the association between sex and skin type to PH. In three out of four studies, PH gradually improved with continued therapy. CONCLUSIONS: Based primarily on cohort studies, PH occurs in 3% of patients undergoing hair removal with lasers or intense pulsed light, yet rarely outside the facial/neck areas. Treatment modality does not seem to be a contributing factor. Continuation of treatment in areas with PH may be the most appropriate treatment.

Long-term outcome of a patient with paradoxical hypertrichosis after laser epilation.

One underreported, rare side effect of laser hair removal is paradoxical hypertrichosis. It is largely unknown what the long-term outcomes are of patients who develop this complication. We report a 21-year-old, Fitzpatrick II, male patient, who had patchy areas of dark hair affecting various body areas. An Alexandrite 755 nm laser was used to address the desired areas at energies between 20 and 22 J/cm2 at 10-12-week intervals over a course of seven treatments. After three treatments, the patient noted a significant increase in the density and length of hairs involving the back, shoulders, neck, and upper arms. The patient was followed on a biannual basis, without further epilatory intervention. After 10 years, the areas of paradoxical hair growth were sparser compared to immediate post-treatment but remained denser compared to pre-treatment. This case illustrates improvement in the condition over time without intervention. Further studies are needed to determine the etiopathogenesis of this phenomenon.

Is paradoxical hair growth caused by low-level radiant exposure by home-use laser and intense pulsed light devices?

INTRODUCTION AND OBJECTIVES: This qualitative review of paradoxical hair growth, following professional treatments reviews, clarifies whether low fluence is the most probable cause of unwanted hair regrowth after at home light-based treatments. MATERIALS AND METHODS: The proposed causes of unexpected hair regrowth are examined, and our scientific understanding of absorption and scattering of light in turbid tissue is reviewed. Published reports of paradoxical hair growth are assessed. RESULTS: Early laser hair removal studies failed to record the occurrence of hair induction despite the significant numbers of subjects treated. Neither published paradoxical hair growth studies following home-based laser or intense pulsed light (IPL) hair removal treatments, nor randomised or controlled studies documenting paradoxical hair growth following professional treatments could be found. Several authors directly proposed inflammatory response to be the primary cause of hair growth induction. CONCLUSIONS: It is unlikely that hair regrowth several centimetres or more away from the irradiated tissue can be attributed to the laser or IPL used. In many cases of paradoxical hair growth, other causes may be responsible for the unexpected hair growth. The primary cause of instances of 'true' paradoxical hair growth is probably limited to darker phototypes with one or more other characteristics including polycystic ovarian syndrome or other androgen hormonal irregularities following high energy treatments with the corresponding inflammatory sequelae.

Laser and energy-based devices' complications in dermatology.

Laser dermatology is an ever-expanding part of the specialty used extensively for both aesthetic and medical conditions. Advances in laser technology have led to an expansion in the number of devices available, with as a consequence an increase in the total number of complications. Fortunately, the current technology has improved greatly which adds to the safety profile of such devices; nevertheless, thorough knowledge of laser complications and how to avoid them is paramount for any practitioner who uses such technology.

Hypertrichosis in Becker's nevus: effective low-fluence laser hair removal.

Becker's nevus is cosmetically bothersome both due to the hyperpigmentation and due to the hypertrichosis which can accompany it, particularly in males. Laser hair removal can be considered, but the pigmented background of the Becker's nevus makes the treatment more challenging. Fifteen patients with Becker's nevus underwent eight sessions of hair removal with low-fluence high-repetition-rate diode lasers (808-810 nm). All participants experienced significant hair reduction at 6 and 12 months. No adverse events were reported. The study supports the use of low fluence with high-repetition-rate diode laser hair removal as a safe and effective method for the management of hypertrichosis in Becker's nevus.

Alopecia: a review of laser and light therapies.

Since the 1980s, laser technology has become increasingly popular to treat a variety of cutaneous conditions. Its successful use as an epilator comes with the rare but interesting side effect of paradoxical hypertrichosis. In this review, we summarize cases describing hair growth after photoepilation, as well as studies testing laser and light sources as treatment for alopecia, particularly androgenetic alopecia and alopecia areata. We also discuss the possible biologic mechanisms by which phototherapy induces hair regeneration.

Paradoxical hypertrichosis and terminal hair change after intense pulsed light hair removal therapy.

BACKGROUND: Although complications such as blister formation, erosion, and post-inflammatory hypo- and hyperpigmentation are well-known side effects of intense pulsed light (IPL) photoepilation, little is known about the paradoxical hypertrichosis after therapy. OBJECTIVE: To report the paradoxically increased hair density and coarseness after IPL photoepilation. METHODS: Within a period of 23 months, a total of 991 hirsute female patients were treated with IPL for photoepilation. The IPL system used was the Vasculight-SR, a multifunctional laser and IPL system (Lumenis Inc., Santa Clara, CA, USA). The cut-off filters frequently used were 695, 755 and 645 nm. RESULTS: Paradoxical hypertrichosis and terminal hair change were detected after a few sessions of IPL therapy among 51 out of 991 patients. Our serial digital photographs, schematic diagrams, and hair counts before and after treatment confirmed the patients' claims. The other more commonly seen complications were epidermal burning with blisters, erosion, and crust formation followed by post-inflammatory hypo- and/or hyperpigmentation. CONCLUSION: Paradoxical hypertrichosis and terminal hair change is a common complication of IPL photoepilation.

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.

CO2 laser desiccation of urethral hair post-penoscrotal hypospadias repair.

BACKGROUND: Proximal urethral defects account for approximately 20% of hypospadiac urethras. Previous surgical interventions involved hair-bearing genital skin which consequently resulted in a hairy urethra, which is seen mainly in older patients. OBJECTIVE: To evaluate the safety and effectiveness of the CO2 laser for urethra hair elimination. METHODS: Four men aged 18-20 years with hairy urethras, who failed electrolysis treatment, were treated with CO2 laser desiccation at low fluences (2-5 watts). The treatments were performed at 1-month intervals. Treatment was continued until no hair was seen. Visual assessment of the hair reduction was recorded. RESULTS: Patients received two to four treatment sessions (average 3.2). On clinical assessment 3 months after the last treatment, outcome was rated excellent (no hair) in all patients. CONCLUSIONS: CO2 laser desiccation should be considered as a therapeutic modality for a hairy urethra, especially after the failure of electrolysis.

Successful and safe treatment of hypertrichosis by high-intensity pulses of noncoherent light in a patient with hepatoerythropoietic porphyria.

Hypertrichosis is a common feature in cutaneous porphyrias, characterized by high accumulation of photoreactive porphyrins. Photothermolysis induced by noncoherent light (755-1200 nm) and energy fluence of 42 J/cm(2) was applied to a patient with hepatoerythropoietic porphyria. Hypertrichosis was almost completely removed after seven sessions without development of skin lesions.

Hipertricosis cubital en dos hermanas gemelas y revisión de la literatura / Hypertrichosis cubiti in two twin sisters and review of the literature

La hipertricosis cubital es un tipo peculiar de hipertricosis circunscrita que puede presentarse de forma esporádica o familiar. Ocasionalmente puede presentarse asociada a otros trastornos, principalmente talla baja. Presentamos dos niñas de 10 años de edad, gemelas univitelinas, afectas de hipertricosis cubital aislada. La presencia de este rasgo en gemelos apoya su origen genético (AU)

Hypertrichosis in PUVA-treated patients.

Fifteen out of twenty-three female patients (65%) receiving PUVA therapy showed signs of moderate to severe hypertrichosis. Only two out of fourteen patients (14%) on UV-A therapy without systemic psoralens developed hypertrichosis. We conclude that hypertrichosis may develop in many patients treated with photochemotherapy.