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.

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.

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.

Efficacy & safety of intense pulsed light therapy for unwanted facial hair: a retrospective analysis in skin of color.

Unwanted facial hair growth is a common esthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation. 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) are commercially available laser devices for hair removal most widely studied. The authors wish to share the efficacy and safety of intense pulse light therapy for permanent facial hair reduction in Indian population.

Crescent-Shaped Hyperpigmentation Following Laser Hair Removal: Case Series of Fifteen Patients.

BACKGROUND AND OBJECTIVES: Post-inflammatory hyperpigmentation (PIH) is a common adverse effect of laser hair removal procedures. This case series emphasizes the under-reported crescent-shaped form of PIH that may occur following laser therapy. This case series sought to assess the potential causes of the distinct, crescent-shaped form of PIH that may arise following laser hair removal procedures, and to examine the concept of thermal versus cryogenic damage, which was discovered accidentally due misalignments between laser-cryogen spurts. STUDY DESIGN/MATERIALS AND METHODS: A retrospective, multicentre case recruitment was undertaken, involving three laser centers and presented in the form of a case series. The included patients were individuals with crescent-shaped PIH following laser hair removal. RESULTS: Fifteen patients were recruited over 12 months. All patients were treated with the GentleLase system (Candella) with built-in cryogen spurt. Prior to the study, only one patient had suffered from PIH following laser hair removal. Most patients improved partially or completely both with and without the use of bleaching compounds. After testing one machine, it was found that the cryogen spurt was misaligned. It was not located in the circle of the laser beam, thereby leaving a crescent shape of uncooled but laser-treated skin. A trial on one patient with cryogen alone did not cause PIH, whereas a trial with the laser alone caused PIH. CONCLUSION: The appearance of crescent-shaped marks following PIH is a distinct and uncommon adverse effect associated with laser hair removal procedures. This case series suggests that it arises due to the malfunctioning of the built-in cryogen spurt device, leading to a deficit in cooling a portion of the treated skin, urging checking the built-in cryogen spurt device. Lasers Surg. Med. © 2020 Wiley Periodicals, LLC.

Fox Fordyce disease: a side effect of laser therapy.

Fox-Fordyce disease (FFD) is an uncommon apocrine disorder. We reported a 26-year-old woman with bilateral axillary pruritic papular lesions following 2 sessions of treatment with Diode (800 nm) laser for axillary hair removal. No lesions were developed in the other treated areas. Topical 0.1% tacrolimus gel was used for her treatment.

Lasers for reduction of unwanted hair in skin of colour: a systematic review and meta-analysis.

Light-based therapies are one of the most effective and widely used strategies for removal of undesired hair, with a broadly favourable safety profile. However, subjects with pigmented skin are found to be more prone to laser-related adverse events. While prolonged pulse-width and longer treatment duration were proposed to minimize adverse events, the optimal treatment option among available phototherapy modalities - long-pulsed (Nd:YAG), pulsed diode and alexandrite lasers as well as intense pulsed light (IPL) - remains unclear, particularly for skin of colour. To determine superiority in terms of effectiveness and tolerability, we conducted a systematic review of literature on different types of in-office laser and IPL for hair removal in subjects with Fitzpatrick skin types III-VI. The meta-analysis was performed using Review Manager (RevMan) version 5.3 and included 12 eligible comparative trials (nine randomized controlled trials and three quasi-randomized). In terms of hair count reduction, pooled effect estimates for long-pulsed ND:YAG laser [OR: 0.26, 95% CI (0.1, 0.78)] and diode laser [standardized mean difference (SMD): -0.11, 95% CI (-0.62, 0.39)] were not statistically significant from those of IPL; in contrast, alexandrite laser was found to be superior to IPL in reducing hair count [SMD: -1.7, 95% CI (-2.6, -0.78)]. In terms of adverse events, the pooled effect estimates favoured long-pulsed Nd:YAG laser to IPL with respect to postinflammatory hyperpigmentation [OR: 0.26, 95% CI: (0.1, 0.78)]. However, both pulsed diode and alexandrite lasers exhibited a comparable safety profile to IPL, despite higher pain scores with lasers. In conclusion, this systematic review suggests that treatment outcomes for different in-office laser devices and IPL in subjects with skin type III-VI are broadly similar; nevertheless, we observed a trend towards greater hair reduction following laser therapy compared with IPL.

Evaluation of Safety and Efficacy of Laser Hair Removal With the Long-Pulsed 755 nm Wavelength Laser: A Two-Center Study With 948 Patients.

BACKGROUND AND OBJECTIVES: Laser hair removal is the most common laser therapy and the third most commonly performed procedure with more than one million treatments in United States in 2016. This retrospective study was conducted to assess long-term efficacy and safety of the 755 nm laser for hair removal. STUDY DESIGN/MATERIALS AND METHODS: Nearly, 3,606 laser treatments were performed with the long-pulsed 755 nm wavelength laser equipped with an epidermal cooling device between 1997 and 2005 and were followed till 2013. Standardized assessments were conducted by two treating physicians and patients at two follow-up intervals. At first follow-up, clearance was assessed by two physicians and clearance and satisfaction by patients. At the second follow-up, patients were assessed if hair clearance sustained compared with the first follow-up. RESULTS: Nine hundred and forty-eight patients with Fitzpatrick skin types I-IV were treated with a total of 3,606 laser treatments in this study. The mean age at the beginning of the study was 35 years (±11), 95.1% of patients were female (n = 902) and 4.9% male (n = 46). Five hundred and seventy-four patients received a minimum of three treatments and an average of 5.31 (3-16) treatments on axilla, back, bikini, breast, abdomen, face, lower extremity, or upper extremity region. First, follow-up was conducted 3.9 (±1.5) years after the final laser treatment. Seventy-four percent of these patients received 75-100% clearance as reported by the physician and 48% clearance as reported by the patient. Fifty-two percent of patients reported slower hair growth and 42% change in hair texture. Ninety percent of patients treated on axilla, 82% treated on the bikini area, and 79% treated on lower extremities experienced 75% or more clearance after three treatments. Facial, as well as breast and abdomen treatments, only showed a 66% and 62%, respectively, after three treatments. For these locations, five and more treatments were needed to achieve a quote of 79% (face) or 80% (breast and abdomen) for a 75-100% clearance. Upper extremity and back treatments did not have enough physician ratings to draw conclusions. Long-term adverse events were minimal and were all located on the face (one patient scar, four patients herpes infection). Second follow-up of 173 patients was conducted after 11.5 years (±2.0) and 87.9% of patients reported that their improvement sustained. CONCLUSIONS: The long-pulsed 755 nm alexandrite laser is a safe and efficacious treatment for the reduction of unwanted body hair with permanent results and high patient satisfaction. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

The "in's and outs" of laser hair removal: a mini review.

Conventional treatments for excessive hair are tedious and time consuming. Laser hair removal has become the leading therapy option for long-term results. It works on the principle of selective photothermolysis, whereby photons destroy the hair follicle while sparing the surrounding tissue. As demand increases, there has been an increase in the regulation of these treatments. Laser hair removal is not risk-free and side effects are associated with the treatment. Adequate training is vital to minimise adverse side effects. Certain countries have regulatory boards that laser operators need to register with, as well as the completion of mandatory hours. Others require laser operators to register with a Care Quality Commission (CQC) to ensure that minimum training and safety standards are met. Currently, in South Africa, the lack of regulatory boards and mandatory hours poses a risk to the public as anyone with little or no qualification is allowed to perform laser hair removal treatments, placing patients at risk. This review looks at some of the devices used and basic mechanisms of action of laser hair removal, its associated risks, side effects and current regulation.

Pseudofolliculitis Barbae: A Review of Current Treatment Options

The purpose of this review is to discuss the disease process and wide variety of treatment options for psuedofolliculitis barbae (PFB), or razor bumps. PFB is caused by hair follicles penetrating the skin and causing an inflammatory response. PFB can occur to anyone who shaves, and is more likely in those with curly hair. PFB can cause significant hyperpigmentation and scarring, more noticeable in darker skin types. PFB can be treated with a variety of topical, systemic, or light/laser therapies. Minimal progress has been made in treating PFB in recent years, partially due to the success of well-established current treatments discussed in this review. The most effective treatments involve a multifaceted approach including behavioral changes in shaving habits as well as the use of topical therapies. J Drugs Dermatol. 2019;18(3):246-250.

Lichen sclerosus associated with Nd:YAG laser therapy.

Laser is the most efficient and popular method in hair removal. The most common side effects of laser assisted hair removal are pain, erythema, edema, hypopigmentation, hyperpigmentation, blistering, crusting, erosions, purpura, folliculitis, and scar formation ( 1 ). Herein, for the first time we describe a case of lichen sclerosus (LS) following hair removal with long pulsed 1064 nm Nd:YAG laser therapy.

Removal of unwanted hair: efficacy, tolerability, and safety of long-pulsed 755-nm alexandrite laser equipped with a sapphire handpiece.

Due to the difference in refraction coefficients between air and the corneal epithelium, irradiation of the skin with a light source can lead to reflection of the energy and its leakage to the skin causes epidermal injury. All of which decreases the efficacy of treatment. We evaluated cooling sapphire handpieces' efficacy in decreasing pain and epidermal injuries and enhancing the treatment outcome in laser hair removal. A total of 49 patients with Fitzpatrick skin types of II to IV were treated for laser hair removal on face, limbs, inguinal, and axillary areas with pulsed 755-nm alexandrite laser equipped with a sapphire handpiece and the cooling system. Hair counts were performed by two independent observers at the baseline and 3 months after the final treatment. A marked reduction in hair regrowth was noted 3 months after the final treatment in all body locations studied. Clinical hair reduction was observed and fully assessed. There were no serious side effects with an average pain score of 4.6 out of 40. The cooled sapphire cylinder tip has been shown to minimize epidermal injury and reduce the system energy leaks to the skin.

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.

Airborne particulate concentration during laser hair removal: A comparison between cold sapphire with aqueous gel and cryogen skin cooling.

BACKGROUND: High concentrations of sub-micron nanoparticles have been shown to be released during laser hair removal (LHR) procedures. These emissions pose a potential biohazard to healthcare workers that have prolonged exposure to LHR plume. OBJECTIVE: We sought to demonstrate that cold sapphire skin cooling done in contact mode might suppress plume dispersion during LHR. METHODS: A total of 11 patients were recruited for laser hair removal. They were treated on the legs and axilla with a 755 or 1064 nm millisecond-domain laser equipped with either (i) cryogen spray (CSC); (ii) refrigerated air (RA); or (iii) contact cooling with sapphire (CC). Concentration of ultrafine nanoparticles <1 µm were measured just before and during LHR with the three respective cooling methods. RESULTS: For contact cooling (CC), counts remained at baseline levels, below 3,500 parts per cubic centimeter (ppc) for all treatments. In contrast, the CSC system produced large levels of plume, peaking at times to over 400,000 ppc. The CA cooled system produced intermediate levels of plume, about 35,000 ppc (or about 10× baseline). CONCLUSIONS: Cold Sapphire Skin cooling with gel suppresses plume during laser hair removal, potentially eliminating the need for smoke evacuators, custom ventilation systems, and respirators during LHR. Lasers Surg. Med. 50:280-283, 2018. © 2017 Wiley Periodicals, Inc.

Side effects from intense pulsed light: Importance of skin pigmentation, fluence level and ultraviolet radiation-A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Intense pulsed light (IPL) is a mainstream treatment for hair removal. Side effects after IPL are known, but risk factors remain to be investigated. The objective of this study was to assess the contribution of skin pigmentation, fluence level, and ultraviolet radiation (UVR) on IPL-induced side effects. METHODS: The study was a blinded, randomized intra-individual controlled trial including 16 healthy subjects with Fitzpatrick Skin Types (FST) II-V. Three test areas were each divided into four sites, randomized to a single IPL exposure of 22, 34, 46 J/cm2 or triple stacking of 46 J/cm2 . Areas were subsequently randomized to no UVR or single solar-simulated UVR exposure of 3 Standard Erythema Dose at 30 minutes or 24 hours after IPL. Each area had a corresponding control, resulting in 15 treatment sites. Follow-up visits were scheduled up to 4 weeks after IPL. Outcome measures were: (i) blinded clinical skin reactions; (ii) objectively measured erythema and pigmentation; (iii) pain measured by visual analog scale (VAS); (iv) histology (H&E, Fontana-Masson); and (v) mRNA-expression of p53. RESULTS: Fifteen subjects with FST II-IV completed the protocol. IPL induced a wide range of skin reactions, including erythema (87% of subjects), purpura (27%), blisters (20%), edema (13%), crusting (13%), hyper- (60%), and hypopigmentation (20%). Darker skin pigmentation and increasing IPL fluence were determinants for IPL-induced side effects (P ≤ 0.002), while a single exposure of UVR did not exacerbate side effects (P ≥ 0.180). Clinical findings were confirmed objectively by reflectance spectrometry and qualitatively by histological changes in skin architecture, inflammatory infiltration, and pigmentation. Marker of cellular DNA damage, that is, p53, did not increase after IPL (P ≥ 0.24). CONCLUSIONS: Skin pigmentation and IPL fluence are major determinants of side effects after IPL exposure, while a single exposure to three SED of UVR at 30 minutes or 24 hours after IPL, does not amplify such side effects. Lasers Surg. Med. 49:88-96, 2017. © 2016 Wiley Periodicals, Inc.

Are lasers superior to lights in the photoepilation of Fitzpatrick V and VI skin types? - A comparison between Nd:YAG laser and intense pulsed light.

BACKGROUND AND OBJECTIVES: There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG laser versus IPL in the darker skin types. STUDY DESIGN/MATERIALS AND METHODS: Thirty-nine patients included in Group-1 were treated with Nd:YAG and 31 in Group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and the results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared. RESULTS: Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p < 0.023). There were no statistically significant differences noticed regarding hyperpigmentation in both the groups (p < 0.115). CONCLUSION: Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups.