MEDLINE Abstracts: Laser Hair Removal
MEDLINE Abstracts: Laser Hair Removal
Alster TS, Bryan H, Williams CM
Arch Dermatol. 2001;137:885-889
Objective: To determine the safety and effectiveness of a long-pulsed Nd:YAG laser at 1064 nm in effecting long-term hair reduction in patients with darkly pigmented skin.
Design: Nonrandomized before-after clinical and histological trial.
Setting: Private practice, ambulatory care facility.
Patients: Twenty women with skin phototypes IV through VI and dark brown to black terminal hair on the face, axillae, or legs.
Intervention: A series of 3 long-pulsed (50-millisecond) 1064-nm Nd:YAG laser treatments at fluences ranging from 40 to 50 J/cm(2) were delivered to the identified treatment areas on a monthly basis by a single operator.
Main Outcome Measures: Global clinical grading scores of comparable before-after treatment photographs were determined by 2 independent medical assessors during each laser session and 1, 3, 6, and 12 months postoperatively. A dermatopathologist reviewed unmarked histological specimens obtained at baseline, immediately after the initial laser treatment, and at 1 and 6 months after the final laser session.
Results: Substantial hair reduction was seen after each of the 3 treatment sessions. Prolonged hair loss was observed 12 months after the final laser treatment (70%-90% hair reduction). Axillary hair was substantially more responsive to laser irradiation than was hair located on the legs and face. Adverse effects included mild to moderate treatment pain and rare occurrences of vesiculation and transient pigmentary alteration without fibrosis or scarring. Histological tissue changes mirrored clinical response rates, with evidence of selective follicular injury without epidermal disruption.
Conclusion: The long-pulsed 1064-nm Nd:YAG laser is a safe and effective method of long-term hair reduction in patients with darkly pigmented skin.
Elman M, Klein A, Slatkine M
J Cutan Laser Ther. 2000;2:17-20
Background: Photo-epilation has become an accepted modality for the removal of unwanted hair. However, adverse effects may occur in darker skin patients. Treatment with the ruby laser is generally advised for skin types I-III. Treatment of over 3000 patients (skin types I-III) in our clinic has resulted in a minimal percentage (approximately 3%) of adverse effects. Increasing pulse duration should allow the epidermis to cool and thus minimize thermal damage so that treatment can be extended to dark skin patients.
Objectives: The purpose of our study was to compare tissue reaction in dark skin patients (skin type IV) after treatment with a long-pulse (20 msec) ruby laser and compare the reaction with a 1 msec ruby laser treatment.
Results: Hair removal efficacy was determined to be similar with both pulse durations, but tissue reaction was more severe, including eschar and hypopigmentation, following treatment of dark skin patients with the 1 msec protocol. Increasing the pulse duration to 20 msec appears to result in safe and efficacious ruby laser treatment even for darker skinned patients.
Handrick C, Alster TS
Dermatol Surg. 2001;27:622-626
Background: Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. Advances in laser technology over the past several years has led to the development and distribution of numerous red and infrared lasers and light sources to address this issue. Despite the impressive clinical results that have been reported with the use of individual laser hair removal systems, long-term comparative studies have been scarce.
Objective: To compare the clinical and histologic efficacy, side effect profile, and long-term hair reduction of long-pulsed diode and long-pulsed alexandrite laser systems.
Methods: Twenty women with Fitzpatrick skin types I-IV and dark terminal hair underwent three monthly laser-assisted hair removal sessions with a long-pulsed alexandrite laser (755 nm, 2-msec pulse, 10 mm spot) and a long-pulsed diode laser (800 nm, 12.5 msec or 25 msec, 9 mm spot). Axillary areas were randomly assigned to receive treatment using each laser system at either 25 J/cm2 or 40 J/cm2. Follow-up manual hair counts and photographs of each area were obtained at each of the three treatment visits and at 1, 3, and 6 months after the final laser session. Histologic specimens were obtained at baseline, immediately after the initial laser treatment, and 1 and 6 months after the third treatment session.
Results: After each laser treatment, hair counts were successively reduced and few patients found it necessary to shave the sparsely regrown hair. Optimal clinical response was achieved 1 month after the second laser treatment, regardless of the laser system or fluence used. Six months after the third and final treatment, prolonged clinical hair reduction was observed with no significant differences between the laser systems and fluences used. Histologic tissue changes supported the clinical responses observed with evidence of initial follicular injury followed by slow follicular regeneration. Side effects, including treatment pain and vesiculation, were rare after treatment with either laser system, but were observed more frequently with the long-pulsed diode system at the higher fluence of 40 J/cm2.
Conclusion: Equivalent clinical and histologic responses were observed using a long-pulsed alexandrite and a long-pulsed diode laser for hair removal with minimal adverse sequelae. While long-term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical within 6 months, suggesting the need for additional treatments to improve the rate of permanent hair removal.
Goldberg DJ, Silapunt S
Dermatol Surg. 2001;27:434-436
Background: Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal have proved unsatisfactory. A variety of laser systems with varying wavelengths, pulse durations, and energy fluences are currently utilized for hair removal. Optimal laser parameters continue to require further investigation.
Objective: To evaluate the efficacy and safety of a long-pulse millisecond Nd:YAG hair removal laser utilizing fluences of either 50, 80, or 100 J/cm2.
Methods: Fifteen subjects were treated with a contact cooled 50 msec Nd:YAG laser at fluences 30, 50, or 100 J/cm2. Reduction in hair regrowth was measured at 3 months after treatment by comparing the terminal hair count to the baseline values. Potential complications were also evaluated.
Results: Average hair reduction at 3 months after treatment was 29%, 29%, and 27% in areas treated with a 50-msec Nd:YAG laser at fluences of 50, 80, and 100 J/cm2, respectively. Although short-term blistering was noted in two subjects, no hyperpigmentation, hypopigmentation, or scarring was observed at 3 months after treatment.
Conclusion: Long-pulse millisecond Nd:YAG laser hair removal with fluences of either 50, 80, or 100 J/cm2 leads to similar efficacy with no significant adverse effects.
Baugh WP, Trafeli JP, Barnette DJ Jr, Ross EV
Dermatol Surg. 2001;27:358-364
Background: Numerous lasers are currently available for hair removal, yet there are still few studies that have examined the role of fluence, light dose, hair color, and treatment number in laser hair reduction.
Objective: To demonstrate the efficacy and safety of a scanning 800 nm diode laser for hair reduction.
Methods: An 800 nm scanning diode laser was used to deliver 24, 38, or 48 J/cm2 to a 3 cm x 3 cm area of skin located on the back, groin/bikini area, or thigh in 36 adult patients with varying shades of brown or black hair. Patients received one to four treatments during the course of the study. Hair loss was evaluated at both 30 and 90 days after final treatment. Biopsies were obtained from 20 consenting patients.
Results: Significant fluence-dependent hair reduction was demonstrated between treatment and control groups. At 48 J/cm2, the highest dose, a mean hair reduction of 43% was achieved 30 days after the final treatment, and 34% was achieved 90 days after the final treatment. Darker hairs were more effectively treated than lighter hairs.
Conclusions: Hair reduction can be safely and effectively achieved using a scanning 800 nm diode laser.
Goldberg DJ, Silapunt S
Lasers Surg Med. 2001;28:159-161
Background: Hirsutism and hypertrichosis are common problems. Laser-assisted hair removal has recently become a popular method to remove unwanted hair. However, histologic changes of the hair follicle after exposure to laser continue to require further investigation.
Objective: To determine the thermal effect of a millisecond Nd:YAG hair removal laser.
Methods: Six patients with black hair were treated with 50 msec pulsed Nd:YAG laser at fluences 30, 50 or 100 J/cm(2). Histologic examinations were performed on each laser-treated site at 24-72 hours after laser exposure.
Results: Fluence-dependent selective thermal injury to follicles was seen. The average depth of acute laser injury at fluences 30, 50 and 100 J/cm(2) were 1.06, 0.85 and 1.11 millimeters, respectively.
Conclusions: Long-pulsed millisecond Nd:YAG lasers produce selective thermal damage of hair follicles. Varied laser fluences used in this study did not statistically alter the degree of thermal injury.
Greppi I
Lasers Surg Med. 2001;28:150-155
Background And Objective: The 810-nm wavelength diode laser can safely and successfully treat all skin types, including dark pigmented skin.
Study Design/Methods: Eight Fitzpatrick level V-VI skin type patients, four of which presented with the diagnosis of pseudofolliculitis barbae, were treated with the diode laser for hair removal using low-energy settings and long pulse duration.
Results: All eight patients had excellent results with unwanted hair greatly reduced, and pseudofolliculitis barbae resolved.
Conclusions: Diode lasers can be used on dark pigmented skin with positive outcomes. Complications such as hypopigmentation, or hyperpigmentation occurred, but all were transient and resolved within a few months.
Kauvar AN
Arch Dermatol. 2000; 136:1343-1346
Background: Pseudofolliculitis barbae is a common disorder in individuals with thick, curly hairs, and treatment options are limited.
Objective: To evaluate the effectiveness of a diode laser in the treatment of pseudofolliculitis barbae.
Design: Observational study.
Setting: Laser and Skin Surgery Center of New York, New York, NY.
Patients: Ten consecutive patients with long-standing pseudofolliculitis barbae and skin phototypes I to IV.
Interventions: Treatment was performed using an 810-nm diode laser (20- to 30-millisecond pulse duration) at fluences of 30 to 40 J/cm(2). Three treatments were performed at 6-to 8-week intervals, and subjects underwent evaluation for improvement in the pseudofolliculitis and the degree of hair reduction.
Main Outcome Measures: Patients were assessed at 6- to 8-week intervals for the degree of hair-count reduction, improvements in papule and pustule formation, and adverse effects.
Results: Complete hair-growth delays of 3 to 8 weeks' duration were produced, and a decrease in hair density of greater than 50% was noted in all subjects 6 to 8 weeks after the last laser treatment. All patients exhibited greater than 50% improvement in the signs of pseudofolliculitis. Preexisting pigmentary changes improved with therapy.
Conclusion: Diode laser treatment is a safe and effective method for improving pseudofolliculitis barbae in patients with skin phototypes I to IV.
Campos VB, Dierickx CC, Farinelli WA, et al
J Am Acad Dermatol. 2000.43:442-447
Background And Objective: Laser hair removal is a relatively new procedure. Our purpose was to study the efficacy and safety of a high-power, pulsed diode laser array for removing unwanted hair.
Methods: A total of 38 subjects were treated with a prototype of the 800-nm diode laser system. Fluences ranging from 10 to 40 J/cm(2) (mean, 33.4 J/cm(2)) were used and 1 to 4 treatments (mean, 2.7) were performed. Evaluation of hair loss was performed at least 4 months after the last treatment (mean, 8.7 months) by a blinded assessment of clinical photographs.
Results: A total of 59% of the subjects had only sparse hair regrowth at the final follow-up. Higher fluences and multiple treatments produced greater long-term efficacy. Transient pigmentary changes occurred in 29% of the subjects and were more common in darker skin types IV to VI (P =. 047).
Conclusion: The 800-nm diode laser is an efficient and safe technique for hair reduction. Adverse pigmentary effects occur, but are transient.
Wagner RF Jr, Brown T, McCarthy EM, McCarthy RA, Uchida T
Dermatol Surg. 2000;26:723-727
Background: As hair removal technology continues to evolve and new equipment comes to market, conflicts may develop between dermatologists and electrologists regarding the professional control and use of these devices.
Methods: A total of 1004 Fellows of the American Academy of Dermatology and 719 electrologists from the southern United States were anonymously surveyed about clinical laser procedures (CLPs).
Results: Compared to electrologists, dermatologists were more likely to support clinical laser regulations that placed licensed physicians in control (P =.001) and preferred that a delegating physician be physically present on the premises when CLPs were performed (P =.001). If a laser device was invented for permanent hair removal that was identical to traditional needle/probe electrolysis in every respect except energy type ("laser fiberoptic probe," LFP), electrologists were more likely than dermatologists to support independent use of this device by electrologists (P =.001). A greater percentage of electrologists from Texas, a state without electrolysis licensing, were more likely to support the unlicensed use of the LFP and CLPs than electrologists from states requiring electrolysis licensing.
Conclusions: These data are consistent with previously published literature and permit a greater understanding of the multiple attitudinal, regulatory, and ethical issues involved when considering delegated and independent CLPs by electrologists.
Rogers CJ, Glaser DA
Dermatol Surg. 2000;26:737-742
Background: Pseudofolliculitis barbae (PFB) is a condition caused by ingrown hairs of the face. No treatment to date has shown long-term effectiveness without risk of side effects or ease of treatment.
Objective: The goal of this pilot study was to evaluate the use of the topical suspension-assisted Q-switched Nd:YAG laser in the treatment of PFB.
Methods: Nine patients were given two treatments 1 month apart and assessed by objective papule/pustule counts at 1 and 2 months after final treatment. Treatment sites were 9 cm2 regions on the mandible and neck, with contralateral controls. Patients also performed subjective evaluations.
Results: Reduction in the quantity of papules and pustules when compared with baseline was statistically significant for treatment of the mandibular region and combined sites at 1- and 2-month evaluations, as well as the neck region at the 2-month evaluation.
Conclusion: Use of the Q-switched Nd:YAG laser with topical carbon suspension is an effective means of treating PFB, with results persisting at least 2 months after treatment.
Dierickx CC
Semin Cutan Med Surg. 2000;19:267-275
Unwanted pigmented hair is a common problem for many patients. Traditional methods of hair removal have included shaving, bleaching, plucking, waxing, use of chemical depilatories, and electrolysis. These techniques have been limited by their pain, inconvenience, and poor long-term efficacy. Only electrolysis has offered the potential for permanent hair removal. However, the technique is tedious, highly operator-dependent, and impractical for the treatment of large numbers of hairs. Recently, a number of lasers and other light sources have been developed specifically to target hair follicles. These include ruby, alexandrite, diode, and Nd:YAG lasers and an intense pulsed light source. These devices offer the potential for rapid treatment of large areas and long-lasting hair removal. This article explains the mechanisms of using light to remove hair, examines the attributes of specific laser systems, and explains the importance of patient selection and treatment protocol for the various systems in order to provide a safe and effective treatment.
Laughlin SA, Dudley DK
J Cutan Med Surg. 2000;4:83-88
Background: Laser epilation is now used widely as a clinical alternative to electrolysis for the removal of unwanted hair. All of the laser systems presently being used produce a reliable temporary hair loss by inducing telogen. Most of the published studies use follow-up periods of 6 months or less after the last treatment and cannot address the issue of permanency. Since many patients desire permanent hair loss, there is a need for specific information on the exact benefits and limitations of each particular system.
Objective: The purpose of this study was to assess the degree of hair loss attained by a single treatment with a 3-msec alexandrite laser. A designated period for follow-up was used to address the issue of long-term benefits.
Methods: A single treatment was carried out on 25 study sites with a 3-msec alexandrite laser at 755 nm using fluences of 30 to 50 joules/cm(2). Hair counts were obtained manually by two independent observers marking terminal hairs under magnification. The counts were repeated using photographic images and the average of the four readings taken. The degree of hair loss was calculated at a time after treatment equal to one complete growth cycle for the particular anatomic site. A second measurement was obtained at a time equal to one growth cycle plus 6 months to determine whether any hair loss had remained stable.
Results: The average hair loss at the first follow-up time was 43%, with 60% of sites showing a hair loss of >30%. The hair loss remained stable and the reduction in hair density at both designated times was statistically significant (p <.05).
Conclusion: A normal-mode alexandrite laser achieves a long-term alopecia and may result in a permanent loss of terminal hair after one treatment at fluences of 30 to 50 joules/cm(2).
MEDLINE Abstracts: Laser Hair Removal
Long-Pulsed Nd:YAG Laser-Assisted Hair Removal in Pigmented Skin: A Clinical and Histological Evaluation
Alster TS, Bryan H, Williams CM
Arch Dermatol. 2001;137:885-889
Objective: To determine the safety and effectiveness of a long-pulsed Nd:YAG laser at 1064 nm in effecting long-term hair reduction in patients with darkly pigmented skin.
Design: Nonrandomized before-after clinical and histological trial.
Setting: Private practice, ambulatory care facility.
Patients: Twenty women with skin phototypes IV through VI and dark brown to black terminal hair on the face, axillae, or legs.
Intervention: A series of 3 long-pulsed (50-millisecond) 1064-nm Nd:YAG laser treatments at fluences ranging from 40 to 50 J/cm(2) were delivered to the identified treatment areas on a monthly basis by a single operator.
Main Outcome Measures: Global clinical grading scores of comparable before-after treatment photographs were determined by 2 independent medical assessors during each laser session and 1, 3, 6, and 12 months postoperatively. A dermatopathologist reviewed unmarked histological specimens obtained at baseline, immediately after the initial laser treatment, and at 1 and 6 months after the final laser session.
Results: Substantial hair reduction was seen after each of the 3 treatment sessions. Prolonged hair loss was observed 12 months after the final laser treatment (70%-90% hair reduction). Axillary hair was substantially more responsive to laser irradiation than was hair located on the legs and face. Adverse effects included mild to moderate treatment pain and rare occurrences of vesiculation and transient pigmentary alteration without fibrosis or scarring. Histological tissue changes mirrored clinical response rates, with evidence of selective follicular injury without epidermal disruption.
Conclusion: The long-pulsed 1064-nm Nd:YAG laser is a safe and effective method of long-term hair reduction in patients with darkly pigmented skin.
Dark Skin Tissue Reaction in Laser Assisted Hair Removal With a Long-Pulse Ruby Laser
Elman M, Klein A, Slatkine M
J Cutan Laser Ther. 2000;2:17-20
Background: Photo-epilation has become an accepted modality for the removal of unwanted hair. However, adverse effects may occur in darker skin patients. Treatment with the ruby laser is generally advised for skin types I-III. Treatment of over 3000 patients (skin types I-III) in our clinic has resulted in a minimal percentage (approximately 3%) of adverse effects. Increasing pulse duration should allow the epidermis to cool and thus minimize thermal damage so that treatment can be extended to dark skin patients.
Objectives: The purpose of our study was to compare tissue reaction in dark skin patients (skin type IV) after treatment with a long-pulse (20 msec) ruby laser and compare the reaction with a 1 msec ruby laser treatment.
Results: Hair removal efficacy was determined to be similar with both pulse durations, but tissue reaction was more severe, including eschar and hypopigmentation, following treatment of dark skin patients with the 1 msec protocol. Increasing the pulse duration to 20 msec appears to result in safe and efficacious ruby laser treatment even for darker skinned patients.
Comparison of Long-Pulsed Diode and Long-Pulsed Alexandrite Lasers for Hair Removal: A Long-Term Clinical and Histologic Study
Handrick C, Alster TS
Dermatol Surg. 2001;27:622-626
Background: Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. Advances in laser technology over the past several years has led to the development and distribution of numerous red and infrared lasers and light sources to address this issue. Despite the impressive clinical results that have been reported with the use of individual laser hair removal systems, long-term comparative studies have been scarce.
Objective: To compare the clinical and histologic efficacy, side effect profile, and long-term hair reduction of long-pulsed diode and long-pulsed alexandrite laser systems.
Methods: Twenty women with Fitzpatrick skin types I-IV and dark terminal hair underwent three monthly laser-assisted hair removal sessions with a long-pulsed alexandrite laser (755 nm, 2-msec pulse, 10 mm spot) and a long-pulsed diode laser (800 nm, 12.5 msec or 25 msec, 9 mm spot). Axillary areas were randomly assigned to receive treatment using each laser system at either 25 J/cm2 or 40 J/cm2. Follow-up manual hair counts and photographs of each area were obtained at each of the three treatment visits and at 1, 3, and 6 months after the final laser session. Histologic specimens were obtained at baseline, immediately after the initial laser treatment, and 1 and 6 months after the third treatment session.
Results: After each laser treatment, hair counts were successively reduced and few patients found it necessary to shave the sparsely regrown hair. Optimal clinical response was achieved 1 month after the second laser treatment, regardless of the laser system or fluence used. Six months after the third and final treatment, prolonged clinical hair reduction was observed with no significant differences between the laser systems and fluences used. Histologic tissue changes supported the clinical responses observed with evidence of initial follicular injury followed by slow follicular regeneration. Side effects, including treatment pain and vesiculation, were rare after treatment with either laser system, but were observed more frequently with the long-pulsed diode system at the higher fluence of 40 J/cm2.
Conclusion: Equivalent clinical and histologic responses were observed using a long-pulsed alexandrite and a long-pulsed diode laser for hair removal with minimal adverse sequelae. While long-term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical within 6 months, suggesting the need for additional treatments to improve the rate of permanent hair removal.
Hair Removal Using a Long-pulsed Nd:YAG Laser: Comparison at Fluences of 50, 80, and 100 J/cm
Goldberg DJ, Silapunt S
Dermatol Surg. 2001;27:434-436
Background: Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal have proved unsatisfactory. A variety of laser systems with varying wavelengths, pulse durations, and energy fluences are currently utilized for hair removal. Optimal laser parameters continue to require further investigation.
Objective: To evaluate the efficacy and safety of a long-pulse millisecond Nd:YAG hair removal laser utilizing fluences of either 50, 80, or 100 J/cm2.
Methods: Fifteen subjects were treated with a contact cooled 50 msec Nd:YAG laser at fluences 30, 50, or 100 J/cm2. Reduction in hair regrowth was measured at 3 months after treatment by comparing the terminal hair count to the baseline values. Potential complications were also evaluated.
Results: Average hair reduction at 3 months after treatment was 29%, 29%, and 27% in areas treated with a 50-msec Nd:YAG laser at fluences of 50, 80, and 100 J/cm2, respectively. Although short-term blistering was noted in two subjects, no hyperpigmentation, hypopigmentation, or scarring was observed at 3 months after treatment.
Conclusion: Long-pulse millisecond Nd:YAG laser hair removal with fluences of either 50, 80, or 100 J/cm2 leads to similar efficacy with no significant adverse effects.
Hair Reduction Using a Scanning 800 nm Diode Laser
Baugh WP, Trafeli JP, Barnette DJ Jr, Ross EV
Dermatol Surg. 2001;27:358-364
Background: Numerous lasers are currently available for hair removal, yet there are still few studies that have examined the role of fluence, light dose, hair color, and treatment number in laser hair reduction.
Objective: To demonstrate the efficacy and safety of a scanning 800 nm diode laser for hair reduction.
Methods: An 800 nm scanning diode laser was used to deliver 24, 38, or 48 J/cm2 to a 3 cm x 3 cm area of skin located on the back, groin/bikini area, or thigh in 36 adult patients with varying shades of brown or black hair. Patients received one to four treatments during the course of the study. Hair loss was evaluated at both 30 and 90 days after final treatment. Biopsies were obtained from 20 consenting patients.
Results: Significant fluence-dependent hair reduction was demonstrated between treatment and control groups. At 48 J/cm2, the highest dose, a mean hair reduction of 43% was achieved 30 days after the final treatment, and 34% was achieved 90 days after the final treatment. Darker hairs were more effectively treated than lighter hairs.
Conclusions: Hair reduction can be safely and effectively achieved using a scanning 800 nm diode laser.
Histologic Evaluation of a Millisecond Nd:YAG Laser for Hair Removal
Goldberg DJ, Silapunt S
Lasers Surg Med. 2001;28:159-161
Background: Hirsutism and hypertrichosis are common problems. Laser-assisted hair removal has recently become a popular method to remove unwanted hair. However, histologic changes of the hair follicle after exposure to laser continue to require further investigation.
Objective: To determine the thermal effect of a millisecond Nd:YAG hair removal laser.
Methods: Six patients with black hair were treated with 50 msec pulsed Nd:YAG laser at fluences 30, 50 or 100 J/cm(2). Histologic examinations were performed on each laser-treated site at 24-72 hours after laser exposure.
Results: Fluence-dependent selective thermal injury to follicles was seen. The average depth of acute laser injury at fluences 30, 50 and 100 J/cm(2) were 1.06, 0.85 and 1.11 millimeters, respectively.
Conclusions: Long-pulsed millisecond Nd:YAG lasers produce selective thermal damage of hair follicles. Varied laser fluences used in this study did not statistically alter the degree of thermal injury.
Diode Laser Hair Removal of the Black Patient
Greppi I
Lasers Surg Med. 2001;28:150-155
Background And Objective: The 810-nm wavelength diode laser can safely and successfully treat all skin types, including dark pigmented skin.
Study Design/Methods: Eight Fitzpatrick level V-VI skin type patients, four of which presented with the diagnosis of pseudofolliculitis barbae, were treated with the diode laser for hair removal using low-energy settings and long pulse duration.
Results: All eight patients had excellent results with unwanted hair greatly reduced, and pseudofolliculitis barbae resolved.
Conclusions: Diode lasers can be used on dark pigmented skin with positive outcomes. Complications such as hypopigmentation, or hyperpigmentation occurred, but all were transient and resolved within a few months.
Treatment of Pseudofolliculitis With a Pulsed Infrared Laser
Kauvar AN
Arch Dermatol. 2000; 136:1343-1346
Background: Pseudofolliculitis barbae is a common disorder in individuals with thick, curly hairs, and treatment options are limited.
Objective: To evaluate the effectiveness of a diode laser in the treatment of pseudofolliculitis barbae.
Design: Observational study.
Setting: Laser and Skin Surgery Center of New York, New York, NY.
Patients: Ten consecutive patients with long-standing pseudofolliculitis barbae and skin phototypes I to IV.
Interventions: Treatment was performed using an 810-nm diode laser (20- to 30-millisecond pulse duration) at fluences of 30 to 40 J/cm(2). Three treatments were performed at 6-to 8-week intervals, and subjects underwent evaluation for improvement in the pseudofolliculitis and the degree of hair reduction.
Main Outcome Measures: Patients were assessed at 6- to 8-week intervals for the degree of hair-count reduction, improvements in papule and pustule formation, and adverse effects.
Results: Complete hair-growth delays of 3 to 8 weeks' duration were produced, and a decrease in hair density of greater than 50% was noted in all subjects 6 to 8 weeks after the last laser treatment. All patients exhibited greater than 50% improvement in the signs of pseudofolliculitis. Preexisting pigmentary changes improved with therapy.
Conclusion: Diode laser treatment is a safe and effective method for improving pseudofolliculitis barbae in patients with skin phototypes I to IV.
Hair Removal With an 800-nm Pulsed Diode Laser
Campos VB, Dierickx CC, Farinelli WA, et al
J Am Acad Dermatol. 2000.43:442-447
Background And Objective: Laser hair removal is a relatively new procedure. Our purpose was to study the efficacy and safety of a high-power, pulsed diode laser array for removing unwanted hair.
Methods: A total of 38 subjects were treated with a prototype of the 800-nm diode laser system. Fluences ranging from 10 to 40 J/cm(2) (mean, 33.4 J/cm(2)) were used and 1 to 4 treatments (mean, 2.7) were performed. Evaluation of hair loss was performed at least 4 months after the last treatment (mean, 8.7 months) by a blinded assessment of clinical photographs.
Results: A total of 59% of the subjects had only sparse hair regrowth at the final follow-up. Higher fluences and multiple treatments produced greater long-term efficacy. Transient pigmentary changes occurred in 29% of the subjects and were more common in darker skin types IV to VI (P =. 047).
Conclusion: The 800-nm diode laser is an efficient and safe technique for hair reduction. Adverse pigmentary effects occur, but are transient.
Dermatologist and Electrologist Perspectives on Laser Procedures by Nonphysicians
Wagner RF Jr, Brown T, McCarthy EM, McCarthy RA, Uchida T
Dermatol Surg. 2000;26:723-727
Background: As hair removal technology continues to evolve and new equipment comes to market, conflicts may develop between dermatologists and electrologists regarding the professional control and use of these devices.
Methods: A total of 1004 Fellows of the American Academy of Dermatology and 719 electrologists from the southern United States were anonymously surveyed about clinical laser procedures (CLPs).
Results: Compared to electrologists, dermatologists were more likely to support clinical laser regulations that placed licensed physicians in control (P =.001) and preferred that a delegating physician be physically present on the premises when CLPs were performed (P =.001). If a laser device was invented for permanent hair removal that was identical to traditional needle/probe electrolysis in every respect except energy type ("laser fiberoptic probe," LFP), electrologists were more likely than dermatologists to support independent use of this device by electrologists (P =.001). A greater percentage of electrologists from Texas, a state without electrolysis licensing, were more likely to support the unlicensed use of the LFP and CLPs than electrologists from states requiring electrolysis licensing.
Conclusions: These data are consistent with previously published literature and permit a greater understanding of the multiple attitudinal, regulatory, and ethical issues involved when considering delegated and independent CLPs by electrologists.
Treatment of Pseudofolliculitis Barbae Using the Q-switched Nd:YAG Laser With Topical Carbon Suspension
Rogers CJ, Glaser DA
Dermatol Surg. 2000;26:737-742
Background: Pseudofolliculitis barbae (PFB) is a condition caused by ingrown hairs of the face. No treatment to date has shown long-term effectiveness without risk of side effects or ease of treatment.
Objective: The goal of this pilot study was to evaluate the use of the topical suspension-assisted Q-switched Nd:YAG laser in the treatment of PFB.
Methods: Nine patients were given two treatments 1 month apart and assessed by objective papule/pustule counts at 1 and 2 months after final treatment. Treatment sites were 9 cm2 regions on the mandible and neck, with contralateral controls. Patients also performed subjective evaluations.
Results: Reduction in the quantity of papules and pustules when compared with baseline was statistically significant for treatment of the mandibular region and combined sites at 1- and 2-month evaluations, as well as the neck region at the 2-month evaluation.
Conclusion: Use of the Q-switched Nd:YAG laser with topical carbon suspension is an effective means of treating PFB, with results persisting at least 2 months after treatment.
Hair Removal by Lasers and Intense Pulsed Light Sources
Dierickx CC
Semin Cutan Med Surg. 2000;19:267-275
Unwanted pigmented hair is a common problem for many patients. Traditional methods of hair removal have included shaving, bleaching, plucking, waxing, use of chemical depilatories, and electrolysis. These techniques have been limited by their pain, inconvenience, and poor long-term efficacy. Only electrolysis has offered the potential for permanent hair removal. However, the technique is tedious, highly operator-dependent, and impractical for the treatment of large numbers of hairs. Recently, a number of lasers and other light sources have been developed specifically to target hair follicles. These include ruby, alexandrite, diode, and Nd:YAG lasers and an intense pulsed light source. These devices offer the potential for rapid treatment of large areas and long-lasting hair removal. This article explains the mechanisms of using light to remove hair, examines the attributes of specific laser systems, and explains the importance of patient selection and treatment protocol for the various systems in order to provide a safe and effective treatment.
Long-Term Hair Removal Using a 3-Millisecond Alexandrite Laser
Laughlin SA, Dudley DK
J Cutan Med Surg. 2000;4:83-88
Background: Laser epilation is now used widely as a clinical alternative to electrolysis for the removal of unwanted hair. All of the laser systems presently being used produce a reliable temporary hair loss by inducing telogen. Most of the published studies use follow-up periods of 6 months or less after the last treatment and cannot address the issue of permanency. Since many patients desire permanent hair loss, there is a need for specific information on the exact benefits and limitations of each particular system.
Objective: The purpose of this study was to assess the degree of hair loss attained by a single treatment with a 3-msec alexandrite laser. A designated period for follow-up was used to address the issue of long-term benefits.
Methods: A single treatment was carried out on 25 study sites with a 3-msec alexandrite laser at 755 nm using fluences of 30 to 50 joules/cm(2). Hair counts were obtained manually by two independent observers marking terminal hairs under magnification. The counts were repeated using photographic images and the average of the four readings taken. The degree of hair loss was calculated at a time after treatment equal to one complete growth cycle for the particular anatomic site. A second measurement was obtained at a time equal to one growth cycle plus 6 months to determine whether any hair loss had remained stable.
Results: The average hair loss at the first follow-up time was 43%, with 60% of sites showing a hair loss of >30%. The hair loss remained stable and the reduction in hair density at both designated times was statistically significant (p <.05).
Conclusion: A normal-mode alexandrite laser achieves a long-term alopecia and may result in a permanent loss of terminal hair after one treatment at fluences of 30 to 50 joules/cm(2).
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