Damage to hair follicles by normal-mode ruby laser pulses

Updates on Lasers in Dermatology

The introduction of selective photothermolysis by Drs. John Parrish and Rox Anderson in 1983 revolutionized how lasers are used in dermatology. The theory allowed for lasers to be used in a variety of applications both safe and effectively, and the number of applications has only expanded with time. From the first application on vascular birthmarks to more recent applications for acne, this review covers the evolution of lasers from the beginning to where we are headed.

Adverse Events of Light-Assisted Hair Removal: An Updated Review

BACKGROUND

With light-assisted hair removal becoming widely used, reports of adverse effects are increasing.

OBJECTIVE

To review all the reported optical incidents and cutaneous complications of laser or intense pulse light-assisted hair removal.

METHODS

A PubMed database systematic search was performed to identify studies reporting such adverse events before July 2022 using the Mesh terms "adverse effects" AND "hair removal" AND ("laser" OR "intense pulse light").

RESULTS

Altogether, 358 references were identified. After excluding duplicates, unrelated articles, guidelines, and conference abstracts, then adding references from studies bibliography, 104 publications were included. Ocular incidents consisted of anterior uveitis, iritis and iris atrophy, pupillary distortion, posterior synechiae, anterior chamber pigment, and cataracts in the anterior subcapsular region. Cutaneous complications consisted of pain, burns, folliculitis, leukotrichia, paradoxical hypertrichosis, pigmentary changes, changes in nevi, pili bigemini, herpes infection, hyperhidrosis, bromhidrosis, Fox-Fordyce disease, and frostbite from the cooling system. They were mostly correlated to skin type and body area as well as to light device and set parameters. Intense pulse light devices were found to be less painful than alexandrite laser, yet more painful than diode laser; Nd:YAG laser had the highest pain score.

CONCLUSION

Optical incidents can be systematically avoided. Cutaneous complications are usually related to professional errors and patient characteristics. Better knowledge of laser physics and adequate training of laser operators are key recommendations to avoid undesirable side effects. Safety recommendations help prevent most of the reported complications.

Utilization of intense pulsed light for hair removal in pediatric auricular reconstruction using tissue expander: A retrospective cohort study

This study aimed to investigate the safety and efficacy of depilation with intense pulsed light (IPL) in congenital microtia patients during their reconstruction treatment. The hairy skin was treated with the M22TM system (Lumenis, German) using a filter of 695 to 1200 mm. A contact prob with a window of 15 cm × 35 mm or 8 cm × 15 mm was used at a radiant setting of 14 to 15 J/cm2 in the non-expander group and 13 to 14 J/cm2 in the expander group, both in a single pulse mode. The efficiency index of hair removal was classified based on the percentage of hair density reduction as excellent (>75%), good (50-75%), fair (25-50%), poor (<25%). The depilation effect was compared between the 2 groups, and any adverse effects were evaluated. A total of 159 patients were included, with 93 patients in the expander group and 66 in the non-expander group. The reduction of the hair density in the expander group after 3 treatments was higher than that in the non-expander group [82.98 (73.47-89.09)% vs 77.84 (71.50-85.34)%; P < .05, Wilcoxon rank-sum test], as well as the efficiency [excellent cases 68 (73.12%) vs 37 (56.06%); P < .05, Chi-square test]. Four cases of folliculitis, 3 cases of blisters, and no instance of expander exposure and cartilage absorption were observed in this study. Hair removal with IPL is a safe and effective photo-epilation method during all stages of ear reconstruction using tissue expander. Depilation in the skin expansion period resulted in better outcomes after 3 treatments, although after 5 treatments no difference between the 2 groups was observed.

Efficacy of Laser in Hair Removal: A Network Meta-analysis

BACKGROUND

Laser hair removal is an increasingly prevalent trend of cosmetic procedures. The purpose of this study was to assess the effectiveness of hair reduction among several types of laser interventions.

METHODS

The selected studies searched in PubMed and EMBASE were assessed for quality of evidence, and extracted data on absolute hair count and hair reduction rate. Qualitative data were synthesized using standardized mean difference (SMD) in frequentist network meta-analysis because various measurement units were used among selected studies. Inconsistency and small study effects were examined by design-by-treatment interaction model and comparison-adjusted funnel plot.

RESULTS

A total of 13 randomized controlled trials (RCTs) (n = 652) were contributed to network meta-analysis. Pooled results revealed that diode laser showed significantly lower absolute hair count within three-month (SMD = -13.21, 95% confidence interval [CI]: -22.25 to -4.17) and around six months follow-up (SMD = -11.01, 95% CI: -18.24 to -3.77) as compared with those in control group, but no significant difference among laser interventions. All side effects observed were transient without leaving any permanent scars.

CONCLUSION

Eliminating unwanted hair with lasers or intense pulsed light is safe and effective; however, which type of intervention is more beneficial in the long-term process should be studied with a longer follow-up time.

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.

Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria

Introduction

Permanent genital hair removal is required before gender-affirming vaginoplasty to prevent hair-related complications. No previous studies have directly compared the relative efficacy, costs, and patient experiences with laser hair removal (LHR) vs electrolysis treatments. Food and Drug Administration (FDA) oversight of medical devices is poorly understood and commonly misrepresented, adversely affecting patient care.

Aim

This study compares treatment outcomes of electrolysis and LHR for genital hair removal and investigates FDA regulation of electrolysis and LHR devices.

Methods

Penile-inversion vaginoplasty and shallow-depth vaginoplasty patients completed surveys about their preoperative hair removal, including procedure type, number/frequency of sessions, cost, and discomfort. Publicly available FDA-review documents and databases were reviewed.

Main Outcomes Measure

Compared to electrolysis, LHR was associated with greater efficiency, decreased cost, decreased pain, and improved patient satisfaction.

Results

Of 52 total (44 full-depth and 8 shallow-depth) vaginoplasty patients, 22 of 52 underwent electrolysis only, 15 of 52 underwent laser only, and 15 of 52 used both techniques. Compared to patients that underwent LHR only, patients that underwent only electrolysis required a significantly greater number of treatment sessions (mean 24.3 electrolysis vs 8.1 LHR sessions, P < .01) and more frequent sessions (every 2.4 weeks for electrolysis vs 5.3 weeks for LHR, P < .01) to complete treatment (defined as absence of re-growth over 2 months). Electrolysis sessions were significantly longer than LHR sessions (152 minutes vs 26 minutes, P < .01). Total treatment costs for electrolysis ($5,161) were significantly greater than for laser ($981, P < .01). Electrolysis was associated with greater pain and significantly increased need for pretreatment analgesia, which further contributed to higher net costs for treatment with electrolysis vs laser. Many LHR and electrolysis devices have been FDA-cleared for safety, but the FDA does not assess or compare clinical efficacy or efficiency.

Clinical Implications

For patients with dark-pigmented hair, providers should consider LHR as the first-line treatment option for preoperative hair removal before gender-affirming vaginoplasty.

Strength and Limitations

This is the first study to compare electrolysis and LHR for genital hair removal. The discussion addresses FDA review/oversight of devices, which is commonly misrepresented. Limitations include the survey format for data collection.

Conclusion

When compared with electrolysis, LHR showed greater treatment efficiency (shorter and fewer treatment sessions to complete treatment), less pain, greater tolerability, and lower total cost. Our data suggests that, for patients with dark genital hair, providers should consider recommending laser as the first-line treatment for permanent genital hair removal before vaginoplasty.

Yuan N, Feldman A, Chin P, et al. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022;10:100545.

Depilatory laser miniaturizes hair by inducing bystander dermal papilla cell necrosis through thermal diffusion

OBJECTIVES

Depilatory laser targeting melanin has been widely applied for the treatment of hypertrichosis. Both selective photothermolysis and thermal diffusion have been proposed for its effect, but the exact mechanism of permanent hair reduction remains unclear. In this study, we explore the role of thermal diffusion in depilatory laser-induced permanent hair loss and determine whether nonpigmented cells are injured by thermal diffusion.

MATERIALS AND METHODS

C57BL/6 mice in anagen and telogen were treated with alexandrite laser (wavelength 755 nm, pulse duration 3 milliseconds, fluence 12 J/cm² , spot size 12 mm), respectively. Histological analysis, terminal deoxynucleotidyl transferase dUTP nick-end labeling assay, and transmission electron microscopic imaging were employed to evaluate the injury to hair follicle (HF) cells. The proliferation status of HF cells was examined by 5-bromo-2'-deoxyuridine pulse labeling. The number of HF stem cells was quantified by fluorescence-activated cell sorting. The size of the regenerated hair was determined by measuring its length and width.

RESULTS

We found that irradiating C57BL/6 mice in anagen with alexandrite laser led to hair miniaturization in the next anagen. In addition to thermal disruption of melanin-containing cells in the precortex region, we also detected necrosis of the adjacent nonpigmented dermal papilla cells due to thermal diffusion. Dermal papilla cells decreased by 24% after laser injury, while the number of bulge stem cells remained unchanged. When the laser was delivered to telogen HFs where no melanin was present adjacent to the dermal papilla, thermal necrosis and cell reduction were not detected in the dermal papilla and no hair miniaturization was observed.

CONCLUSION

Our results suggest that depilatory laser miniaturizes hair by inducing thermal necrosis of dermal papilla cells due to secondary thermal diffusion from melanin-containing precortex cells in the anagen hair bulbs.

Three wavelengths integrated: Efficacy and safety of a novel combination for hair removal

BACKGROUND

Laser hair removal is one of the most popular aesthetic procedures.

AIMS

The study aimed to assess the efficacy and safety of a novel applicator combining three wavelengths (1064 nm, 810 nm, and 755 nm) for hair removal.

PATIENTS/METHODS

This prospective study included a four-session hair removal treatment with three wavelengths combined and emitted simultaneously using an in-motion technique. Patients were treated in eight-week intervals between each session and a follow-up of 3 months.

RESULTS

Twenty-two men (mean age 41.5 years, SD = 6.1) were included: two (9.1%) Fitzpatrick skin type II, 19 (86.4%) type III, and one (4.5%) type IV. Treated areas were two abdomens (14%), fourteen backs (64%), and five thoraxes (23%). Hair characteristics were evaluated with a dermatoscopic imaging system. Three months after the last session, the mean decrease in the hair count was of 75.6% (SD 5.9) (p < 0.0001), in hair density of 75.6% (SD 5.9) (p < 0.0001), in the terminal hair number of 60.1% (SD 55.0) (p < 0.0001), and in the vellus hair number of 39.7% (SD 72.9) (p = 0.0001).

CONCLUSION

The combined three different wavelengths in a single device provided a wide range of absorption and penetration, allowing for a safe and effective treatment.

Complications of laser hair removal-How we could reduce them?

Laser hair removal became a very popular intervention, with a permanently increasing number of procedures being performed worldwide. The procedure is often performed by nonmedical personnel, and even by untrained personnel, that could be associated with different kind of adverse events, from mild to serious. The complications associated could be lower if the operators understand the basic of laser physics and the working principles of devices. We propose a simple acronym, WATCH, in order to increase the safety and efficiency of laser interventions.

Comparison of efficacy and safety of a novel 755-nm diode laser with conventional 755-nm alexandrite laser in reduction of axillary hairs

The aim of this study was to compare the efficacy and safety of a novel diode system emitting 755 nm wavelength with conventional 755 nm alexandrite laser in skin types III and IV. It was a randomized, right-left comparison, assessor-blind, clinical study. Sixteen female volunteers age 29.52 ± 9.52 were randomly assigned to receive six treatment sessions using 755 nm diode laser on one axilla and 755 nm alexandrite on the opposite axilla. Efficacy was assessed by counting of hairs per square centimeter, 6 months after the last treatment. Treatment outcome was also evaluated by blind reviewing of before and after pictures, using Physician Global Assessment scale (GAS). Subject satisfaction was assessed using visual analogue scale (VAS), pain level and adverse effects were recorded. Skin biophysical parameters (transepidermal water loss, skin sebum, and erythema index) were also measured. Significant reduction in hair count was observed, 6 months after the last treatment session, for both devices (- 33% for 755 nm diode and - 35% for 755 nm alexandrite; p value = 0.85). The mean GAS score was 2.66 for alexandrite treated side vs. 2.00 for diode treated side (p value = 0.036). No severe adverse events were reported. The subject satisfaction score was significantly higher after treatment with alexandrite laser. No significant changes were detected in none of skin biophysical parameters. 755 nm diode laser is suitable for hair removal procedures and it is as effective and safe as the 755 nm alexandrite laser in skin types III-IV.

Light-based home-use devices for hair removal: Why do they work and how effective they are?

OBJECTIVES

This review has the following objectives: Firstly, it provides an explanation of the evolution of laser/intense pulsed light (IPL) hair reduction modalities from high fluence professional devices to low fluence home-use appliances. Secondly, it summarises published literature reviews on home-use devices (HUDs) as evidence of their growing credibility. Thirdly, it proposes mechanistic differences in light delivery regimes and the resulting divergences in mode of action.

MATERIALS AND METHODS

An extensive literature search was performed to review the progress of laser/IPL-induced hair reduction and determine what evidence is available to explain the mode of action of professional and HUDs for hair removal. Establishing the likely biological mode of action of professional high-fluence systems versus home-use low-fluence appliances was performed by combining data obtained using ex vivo hair follicle (HF) organ culture and the clinical results involving human participants.

RESULTS

Significant basic science and clinical evidence has been published to confirm the clinical efficacy and technical safety of many laser and IPL home-use devices for hair removal. Clearly, HUDs are different compared to professional systems both in terms of fluence per pulse and in terms of biological mechanisms underlying hair removal. Here we presented data showing that a single low fluence pulse of both 810 nm laser (6.6 J/cm² , 16 ms) and IPL (9 J/cm² , 15 ms and 6.8 J/cm² , 1.9 ms) leads to induction of catagen transition. Catagen transition was characterized by morphological changes similar to what occurs in vivo with occasional detection of apoptosis in the dermal papilla and outer root sheath cells. This suggests that high hair reduction can be expected in vivo and longer-term treatment might result in HF miniaturization due to a cumulative effect on the dermal papilla and outer root sheath cells. In line with this hypothesis, in this review we demonstrate that long-term application of a commercially-available home-use IPL appliance resulted in persistent hair reduction (80%) one year after last treatment. These data are in line with what was previously reported in the literature, where clinical studies with home-use IPL appliances demonstrated high efficacy of hair reduction on female legs, armpits and bikini zones, with full hair regrowth after four treatments following cessation of IPL administration. Limitations of HUDs include lack of hair clearance for very dark skin types and low speed of treatment compared with professional devices. Numerous uncontrolled and controlled clinical efficacy studies and technical safety investigations on consumer-use appliances support many of the leading manufacturers' claims.

ANALYSIS & CONCLUSIONS

Manufacturers make consumer appliances safe and easy to use by considering "human factors," needs and capabilities of a variety of users. Safety is of primary concern to manufacturers, regulators and standards bodies as these appliances may be accessible to children or their use attempted on unsuitable skin types without full awareness of potential side effects. Consumer cosmetic appliances are provided with warnings and obvious safety notices describing the nature of any ocular or dermal hazard and precautions for reducing risk of accidental injury, infection, etc. HUDs employing optical energy are provided with design and engineering controls such as safety switches, alarms and sensors to prevent their incorrect operation or eye exposure. In-vivo studies demonstrated that low fluence home-use hair removal devices can result in high hair reduction efficacy after a short treatment regime, while prolonged and less frequent (once in six weeks) maintenance treatment over a year can lead to high and sustained hair reduction even one year after cessation of treatment. Home-use hair removal devices can be a useful adjunct to professional in-office treatments with high professional awareness. There are sufficient positive arguments for practitioners to make the case to patients for HUDs as "companion" products to professional treatments. In addition, devices for hair removal can be used effectively as stand-alone products by the consumer if they are willing to adopt a regime of regular or frequent use. Further clinical studies involving dynamic observation of HF cycle stage and type (terminal vs. vellus) over the total duration of treatment, for example, using biopsies or non-invasive imaging are necessary to confirm the proposed mode of action of low fluence pulses in a combination with treatment and maintenance regimes. Lasers Surg. Med. 51:481-490, 2019. © 2019 Wiley Periodicals, Inc.

Randomized, side-by-side comparison of a topical photo-enhancer gel for hair removal: an efficacy and safety study

Background: Novel protocols are evolving to enhance hair follicle damage while preserving safety and improving efficacy. Objectives: The safety and tolerability of a 755-nm diode laser was compared to a combined laser with topical photo-enhancer gel ("combined") versus laser alone ("solo"). Methods: Twenty women (age 23-33 years old), Fitzpatrick skin type I-V, were randomized to side-by-side comparisons with a laser hair removal protocol. The combined side received reduced laser energy compared to the solo side. The laser used in-motion super hair removal technology. Subjects received up to four treatments. Subjects were assessed at baseline and at 1 and 6 months after the last treatment. Results: At the 1-month follow-up, there were no statistical differences in percent hair reduction between the combined (81 ± 16%) versus the solo (77 ± 15%) protocols (p > 0.05). Similarly, at 6-month follow-up, there are no statistical differences between the combined (71 ± 24%) versus the solo (70 ± 23%) treatment protocols (p > 0.05). The average accumulative laser energy in the combined side was half of the solo side (4.2 ± 1.6 vs. 7.6 ± 2.7 kJ, respectively). Pain during the procedure was significantly higher in the solo (5.5 ± 1.8) versus the combined (3.8 ± 1.7) protocol (p < 0.001). Conclusion: A laser hair removal paradigm that combines a 755-nm diode laser with a photo-enhancer gel (reduced kJ protocol) is clinically effective as a solo treatment protocol.

Trichogenic Photostimulation Using Monolithic Flexible Vertical AlGaInP Light-Emitting Diodes

Alopecia is considered an aesthetic, psychological, and social issue among modern people. Although laser-induced skin stimulation is utilized for depilation treatment, such treatment has significant drawbacks of high energy consumption, huge equipment size, and limited usage in daily life. Here, we present a wearable photostimulator for hair-growth applications using high-performance flexible red vertical light-emitting diodes (f-VLEDs). Flexible microscale LEDs were effectively fabricated by a simple monolithic fabrication process, resulting in high light output (∼30 mW mm^-2), low forward voltage (∼2.8 V), and excellent flexibility for wearable biostimulation. Finally, trichogenic stimulation of a hairless mouse was achieved using high-performance red f-VLEDs with high thermal stability, device uniformity, and mechanical durability.

Laser Hair Depilation in the Treatment of Pilonidal Disease: A Systematic Review

BACKGROUND

Laser hair depilation has shown promise in small series of patients with pilonidal sinus disease. The purpose of this study was to review the published literature on laser hair depilation in pilonidal disease to determine its effect on disease recurrence.

METHODS

The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched to identify all studies published through December 1, 2017 that examined the role of laser hair depilation in the treatment of pilonidal sinus disease. Study characteristics, including design, treatment regimen, number of patients evaluated, rate of recurrence, and duration of follow up were recorded.

RESULTS

Thirty-five published studies were included. Of these, 28 studies were retrospective and seven were prospective. There were five comparative studies: two retrospective, one prospective observational, and two randomized controlled trials. The number of patients included in each study ranged from one to 86 patients and patients received between one and 11 laser treatments. The pilonidal disease recurrence rate after laser depilation ranged from 0% to 28% at a mean follow-up ranging from 6 months to 5 years across studies. Four of the five studies that included a comparative group demonstrated a decreased recurrence rate compared to the non-laser cohort.

CONCLUSION

Laser hair depilation is a promising therapy in the management of pilonidal disease. However, the literature published to date is heterogeneous and has limited generalizability. Additional research is needed to determine the effectiveness of laser hair depilation to prevent pilonidal disease recurrence.

Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline

OBJECTIVE

To update the "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2008.

PARTICIPANTS

The participants include an Endocrine Society-appointed task force of seven medical experts and a methodologist.

EVIDENCE

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.

CONSENSUS PROCESS

Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.

CONCLUSION

We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen-progestin contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For most women who choose hair removal therapy, we suggest laser/photoepilation.

A Pilot Study on the Evaluation of Physicians' Laser Delivery Performance Using a Laser Beam Detection Kit

BACKGROUND AND OBJECTIVE

Many laser devices have been developed over the past decades for various skin conditions. However, variations in the technical skill of physicians for laser skin treatment delivery have not yet been evaluated. This study evaluates the differences in omission and overlap percentages during simulated laser hair removal treatments among physicians at two clinics.

MATERIALS AND METHODS

A laser beam detection kit was developed to record and collect laser irradiation from a diode laser device. Eight physicians (primary private clinic 4, tertiary referral hospital 4) were recruited to perform 80 trials of laser delivery simulation. The simulation process was captured in video frames by a camera built inside of the detection kit. The laser distribution map was reconstructed, and each physician's performance result was determined by a computer calculation.

RESULTS

Various assumption tests showed that each physician had different laser delivery skills. Four physicians from clinic A had an average omission rate of 13.4%, and four physicians from clinic B had an average omission rate of 19.7%. Regarding the average overlap rate of the two clinics, clinic A had a higher rate than clinic B (26.1% vs. 14.6%).

CONCLUSIONS

The study's findings confirmed the differences of the technical skills among the physicians and between the two clinics. The proposed computer-assisted evaluation of technical skill is useful for assessing physicians' performance during laser skin treatments.

Ocular injuries secondary to alexandrite laser-assisted hair removal

PURPOSE

The aim of this study was to describe the clinical manifestations and outcomes of 4 patients who had sustained eye injury during alexandrite laser-assisted hair removal.

METHODS

This was a retrospective case series of 4 patients who presented to 2 tertiary eye care hospitals over 2 years. Data on ophthalmic examination, spectral domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany), and fundus fluorescein angiography were collected.

RESULTS

Four female patients sustained injuries during alexandrite laser hair removal. One patient presented with acute anterior uveitis, 2 patients with subfoveal choroidal neovascularization, and 1 patient with intraretinal foveal hemorrhage. Visual acuity at last follow-up (range 3-6 months) was 20/15 to 20/20.

CONCLUSIONS

Ocular injuries can occur as a result of incorrect use of laser-assisted hair removal devices. Ophthalmologists should be aware of ocular damage caused by these devices.

Occupational exposures and determinants of ultrafine particle concentrations during laser hair removal procedures

BACKGROUND

Occupational exposures to ultrafine particles in the plume generated during laser hair removal procedures, the most commonly performed light based cosmetic procedure, have not been thoroughly characterized. Acute and chronic exposures to ambient ultrafine particles have been associated with a number of negative respiratory and cardiovascular health effects. Thus, the aim of this study was to measure airborne concentrations of particles in a diameter size range of 10 nm to 1 μm in procedure rooms during laser hair removal procedures.

METHODS

TSI Model 3007 Condensation Particle Counters were used to quantify the particle count concentrations in the waiting and procedure rooms of a dermatology office. Particle concentrations were sampled before, during, and after laser hair removal procedures, and characteristics of each procedure were noted by the performing dermatologist.

RESULTS

Twelve procedures were sampled over 4 days. Mean ultrafine particle concentrations in the waiting and procedure rooms were 14,957.4 particles/cm³ and 22,916.8 particles/cm³ (p < 0.0001), respectively. Compared to background ultrafine particle concentrations before the procedure, the mean concentration in the procedure room was 2.89 times greater during the procedure (p = 0.009) and 2.09 times greater after the procedure (p = 0.007). Duration of procedure (p = 0.006), body part (p = 0.013), and the use of pre-laser lotion/type of laser (p = 0.039), were the most important predictors of ultrafine particle concentrations. Use of a smoke evacuator (a recommended form of local exhaust ventilation) positioned at 30.5 cm from the source, as opposed to the recommended 1-2 in., lowered particle concentrations, but was not a statistically significant predictor (p = 0.49).

CONCLUSIONS

Laser hair removal procedures can generate high exposures to ultrafine particles for dermatologists and other individuals performing laser hair removal, with exposure varying based on multiple determinants.

Light in diagnosis, therapy and surgery

Light and optical techniques have made profound impacts on modern medicine, with numerous lasers and optical devices being currently used in clinical practice to assess health and treat disease. Recent advances in biomedical optics have enabled increasingly sophisticated technologies — in particular those that integrate photonics with nanotechnology, biomaterials and genetic engineering. In this Review, we revisit the fundamentals of light–matter interactions, describe the applications of light in imaging, diagnosis, therapy and surgery, overview their clinical use, and discuss the promise of emerging light-based technologies.

Precise Spatially Selective Photothermolysis Using Modulated Femtosecond Lasers and Real-time Multimodal Microscopy Monitoring

The successful application of lasers in the treatment of skin diseases and cosmetic surgery is largely based on the principle of conventional selective photothermolysis which relies strongly on the difference in the absorption between the therapeutic target and its surroundings. However, when the differentiation in absorption is not sufficient, collateral damage would occur due to indiscriminate and nonspecific tissue heating. To deal with such cases, we introduce a novel spatially selective photothermolysis method based on multiphoton absorption in which the radiant energy of a tightly focused near-infrared femtosecond laser beam can be directed spatially by aiming the laser focal point to the target of interest. We construct a multimodal optical microscope to perform and monitor the spatially selective photothermolysis. We demonstrate that precise alteration of the targeted tissue is achieved while leaving surrounding tissue intact by choosing appropriate femtosecond laser exposure with multimodal optical microscopy monitoring in real time.

Development of a Novel Automated Hair Counting System for the Quantitative Evaluation of Laser Hair Removal

OBJECTIVE

We aimed to develop and validate a novel computer-assisted automated hair counting system for the quantitative evaluation of laser hair removal (LHR).

METHODS

We developed a computer-aided image processing system to count hairs on shaved skin and validated its performance through clinical trials. Five volunteers of Fitzpatrick skin type III-IV volunteered and were tested on both thighs. The system automatically detects hair and places a "+" sign on each hair site for every positive detection. This method allows clinicians to check whether a hair has been counted or not. We analyzed the difference in the hair counts between the proposed system (automatic) and those by human observers (manual).

RESULTS

The hair counts from the proposed system and the manual counts were compared. The percentage error between automatic and manual counting was <5% in each subject. The data of the two groups were statistically verified with Student's independent t-test. The averages were statistically equivalent between the two groups. The proposed system showed significant time saving in terms of counting.

CONCLUSIONS

A dependable, accurate, and fast method of counting hairs on shaved skin through a computer-aided image processing system was developed and validated. The "+" signs on the image to indicate detection allows clinicians to compare with the original image and detect any omission or redundancy. The proposed system is expected to be reliable in analyzing the results of multiple skin-related treatments, including LHR and hair transplantation. Further, it is expected to be widely applicable for use in the clinic.

Nonpigmented hair removal using photodynamic therapy in animal model

BACKGROUND AND OBJECTIVE

Lasers have been successfully used for decades to remove dark hair. However, laser removal of nonpigmented hair is challenging due to the lack of chromophores. The aim of this study was to use photodynamic therapy (PDT) to remove nonpigmented hair.

STUDY DESIGN/MATERIAL AND METHODS

We compared the efficacy of permanent hair reduction in white BALB/c and black C57BL/6 mice treated with PDT or an 800-nm diode laser. We collected skin biopsy specimens and investigated post-PDT histologic changes and molecular changes.

RESULTS

We observed keratin 15 staining in the bulge area and alkaline phosphatase staining in the dermal papilla following PDT. We observed a temporary, catagen-like transformation in nonpigmented hair follicles after PDT. We observed apoptotic cells in the hair matrix after PDT. Irradiation with an 800-nm diode laser did not achieve nonpigmented hair removal. Multiple PDT sessions achieved permanent reduction of nonpigmented hair. Interestingly, removal of black hair using PDT was less efficient.

CONCLUSION

Our results suggest that PDT can damage the nonpigmented hair matrix, but not stem cells or dermal papillae. Repeated PDT may impair the hair-regeneration capacity via a bystander effect on bulge stem cells or dermal papillae. In this study, we found it was possible to remove nonpigmented hair using PDT. Lasers Surg. Med. 48:748-762, 2016. © 2016 Wiley Periodicals, Inc.

Safety and efficacy of low fluence, high repetition rate versus high fluence, low repetition rate 810-nm diode laser for axillary hair removal in Chinese women

BACKGROUND

High-fluence diode lasers with contact cooling have emerged as the gold standard to remove unwanted hair. Lowering the energy should result in less pain and could theoretically affect the efficacy of the therapy.

OBJECTIVE

To compare the safety and efficacy of a low fluence high repetition rate 810-nm diode laser to those of a high fluence, low repetition rate diode laser for permanent axillary hair removal in Chinese women.

METHODS

Ninety-two Chinese women received four axillae laser hair removal treatments at 4-week intervals using the low fluence, high repetition rate 810-nm diode laser in super hair removal (SHR) mode on one side and the high fluence, low repetition rate diode laser in hair removal (HR) mode on the other side. Hair counts were done at each follow-up visit and 6-month follow-up after the final laser treatment using a "Hi Quality Hair Analysis Program System"; the immediate pain score after each treatment session was recorded by a visual analog scale.

RESULTS

The overall median reduction of hair was 90.2% with the 810-nm diode laser in SHR mode and 87% with the same laser in HR mode at 6-month follow-up. The median pain scores in SHR mode and in HR mode were 2.75 and 6.75, respectively.

CONCLUSION

Low fluence, high repetition rate diode laser can efficiently remove unwanted hair but also significantly improve tolerability and reduce adverse events during the course of treatment.

The role of lasers and intense pulsed light technology in dermatology

The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice.

Pain management in photoepilation

The hair follicle is a complex, hormonally active structure with permanent and cyclically renewed parts which are highly innervated by myelinated and unmyelinated afferent fibers. Hair removal, a very ancient practice, affects this sensory network and causes both acute and diffuse pain associated with inflammatory reaction. Optic permanent hair removal is becoming a popular alternative to traditional methods such as shaving, waxing, among other methods. These optical removal devices thermally destroy the target chromophore, that is, melanin, without damaging the surrounding skin. The increase in the skin surface temperature causes mild-to-severe pain, and optical hair removal has to be combined with pain relieving devices. Pain management relies on topical anesthetic agents, cooling devices, or non-noxious cutaneous stimulation whose mechanisms of action and efficiency are discussed in this article.

Efficacy and Safety of Hair Removal with a Long-Pulsed Diode Laser Depending on the Spot Size: A Randomized, Evaluators-Blinded, Left-Right Study

BACKGROUND

The efficacy of the long-pulsed diode laser (LPDL) in hair removal is determined with various physical parameters. Recently, LPDLs with a larger spot size are commercially available; however, the independent effect of spot size on hair removal has not been studied.

OBJECTIVE

This study aimed to compare the efficacy of the LPDL in hair removal depending on the spot size.

METHODS

A randomized, evaluators-blind, intrapatient comparison (left vs. right) trial was designed. Ten healthy Korean women received three hair removal treatment sessions on both armpits with the 805-nm LPDL and followed for 3 months. A 10×10 mm handpiece (D1) or a 10×30 mm handpiece (D3) was randomly assigned to the right or left axilla. The fluence, pulse duration, and epidermal cooling temperature were identical for both armpits. Hair clearance was quantified with high-resolution photos taken at each visit. Postprocedural pain was quantified on a visual analogue scale. Adverse events were evaluated by physical examination and the patients' self-report.

RESULTS

The mean hair clearance at 3 months after three treatment sessions was 38.7% and 50.1% on the armpits treated with D1 and D3, respectively (p=0.028). Procedural pain was significantly greater in the side treated with D3 (p=0.009). Serious adverse events were not observed.

CONCLUSION

Given that the pulse duration, fluence, and epidermal cooling were identical, the 805-nm LPDL at the three times larger spot size showed an efficacy improvement of 29.5% in axillary hair removal without serious adverse events.

Lasers and Intense Pulsed Light Hidradenitis Suppurativa

Lasers and intense pulsed light (IPL) treatment are useful for the treatment of hidradenitis suppurativa (HS). Carbon dioxide lasers are used for cutting or vaporization of the affected area. It is a effective therapy for the management of severe and recalcitrant HS with persistent sinus tract and scarring, and can be performed under local anesthesia. HS has a follicular pathogenesis. Lasers and IPL targeting the hair have been found useful in treating HS by reducing the numbers of hairs in areas with HS. The methods have few side effects, but the studies are preliminary and need to be repeated.

Comparative Study of Diode Laser Versus Neodymium-Yttrium Aluminum: Garnet Laser Versus Intense Pulsed Light for the Treatment of Hirsutism

INTRODUCTION

Lasers are widely used for the treatment of hirsutism. But the choice of the right laser for the right skin type is very important. Before starting with laser therapy, it is important to assess the skin type, the fluence, the pulse duration and the type of laser to be used.

AIMS

To compare the efficacy and side effects of Diode laser, Neodymium-yttrium aluminum - garnet (Nd: YAG) laser and intense pulsed light (IPL) on 30 female patients of hirsutism.

MATERIALS AND METHODS

Thirty female patients with hirsutism were selected for a randomised controlled study. The patients were divided into three groups of 10 patients each. In group I patients diode laser was used, in group II patients long pulsed Nd: YAG laser was used and in group III, IPL was used. The patients were evaluated and result graded according to a 4-point scale as excellent, >75% reduction; good, 50-75% reduction; fair; 25-50% reduction; and poor, <25% reduction in hair density.

RESULTS

It was seen that the percentage of hair reduction after two sessions of treatment was maximum (40%) in the diode laser group, followed by 35% hair reduction in the Nd: Yag laser group and 10% hair reduction in the IPL group. The percentage of hair reduction after four sessions of treatment was maximum (64%) in the diode laser group, followed by 62% hair reduction in the Nd: Yag laser group and 48% hair reduction in the IPL group. The percentage of hair reduction after eight sessions of treatment was maximum (92%) in the diode laser group, followed by 90% hair reduction in the Nd: YAG group and 70% hair reduction in the IPL group.

CONCLUSIONS

To conclude for the Indian skin with dark hairs, the diode laser still stands the test of time. But, since the diode laser has a narrow margin of safety, proper pre and post-procedure cooling is recommended. Although, the side effects of Nd: YAG laser are less as compared to the diode laser, it is less efficacious as compared to the diode laser.

Effect of 27-MHz radiofrequency on hair follicles: histological evaluation of skin treated ex vivo

BACKGROUND

A multitude of methods and treatments exist for cosmetic hair removal. Electroepilation is a commonly performed method of hair removal that is so-called "permanent"; however, there is a paucity of histological studies of the effects of radiofrequency (RF) on hair follicles.

OBJECTIVE

This study aimed to observe the destruction of human hair follicles and surrounding tissue after the treatment with 27.12-MHz RF, with more attention paid to the thermal destruction of bulge and bulb/dermal papilla.

METHODS

Human scalp specimens obtained during face-lift surgery were treated with 27.12-MHz RF. The probe tip was inserted into hair follicle, RF current was applied, and treated specimens were processed for histological analysis.

RESULTS

Significant damages were observed on treated hair follicles. Thermal damage was lance-shaped and extended over several hundred micrometers (100-400 μm). The location of destruction areas varied, likely depending on the point of insertion of the probe. The epidermis remained intact.

CONCLUSION

This study shows that the general mechanism of thermolysis is to generate damage to cells and tissues surrounding the insertion point of the filament. The results suggest that if the insertion point is close to the bulge region, there is a risk to destroy hair follicle epithelial stem cells.

From flint razors to lasers: a timeline of hair removal methods

Today, most do not go a day without practicing or hearing about new hair removal methods. However, little is discussed about the history of hair removal and the development of most hair removal methods since the period of cavemen. Avoiding decapitation and fitting in with society are two of many reasons for the development of this now normative practice. Knowledge of the hair growth cycle is vital in understanding the efficacy of various hair removal methods as well as the difference between epilation and depilation. While laser hair removal (LHR) is one of the most common cosmetic procedures practiced in the world, according to the FDA, the only current permanent form of hair removal is electrolysis. These two methods as well as various other ones are discussed in this article. Further developments are being made every day to better treat the removal of blonde and white hair as well as to diminish the pain of hair removal. With these developments, dermatologists will better understand the advancement of hair removal methods and the reasons why patients may seek treatment.

Current status of surgery in dermatology

An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.

Evaluation of a hot-wire hair removal device compared to razor shaving

BACKGROUND AND OBJECTIVES

We describe a blinded, controlled, prospective clinical study of a hot-wire device promoted for hair removal and the reduction or delay of hair regrowth (no!no!, Radiancy, Inc., Orangeburg, NY) compared to a shaving control.

STUDY DESIGN/MATERIALS AND METHODS

Twenty-two subjects were treated by trained clinical staff with the hot-wire device according to its Instructions for Use on the lower leg two times per week for 8 weeks. An adjacent site was shaved with a razor blade on the same schedule to provide a control. Subjects were followed for 3 months after the last treatment to study the durability of the results. Standardized high-resolution photographs were made at baseline, once a week during treatment, and monthly during the post-treatment follow-up period. Micro-tattoos were used to ensure treatments and photographs were reliably made in the same anatomical location from visit to visit. Both active and control sites were shaved prior to baseline and allowed to regrow for a fixed period of time before first treatment to provide a consistent and well-defined baseline hair condition. Quantitative hair counts were made by a third party from the photographs and standard statistical analysis was performed to look for differences between the active and control sites. Visual assessments and quantitative analysis was also performed on the photographs to see if there were any differences in hair thickness (diameter) and hair color between the active and control sites.

RESULTS

The results show that shaving and the hot-wire device are indistinguishable in short-term or long-term effect, based on both visual assessment of the photographs and statistical analysis of the hair counts. The control (shaving) had a mean baseline hair count of 79.4, which remained stable (74.8-84.3) during the 8 week-treatment phase and climbed substantially after stopping treatment to 98.8, 100.1, and 104.6 at 1, 2, and 3 months post-treatment, respectively. The active (hot-wire device) had a mean baseline hair count of 86.0 which remained fairly stable (81.7-95.1) during the treatment phase and then climbed substantially after stopping treatment to 104.0, 106.4, and 109.0 at 1, 2, and 3 months post-treatment, respectively. The difference in hair counts between the control and shaving showed that (a) in the treatment phase, shaving was slightly more effective at hair removal than the hot-wire device with weak statistical significance (P < 0.05 at 5 of 7 time points) and (b) in the follow-up phase, shaving and the hot-wire device were statistically indistinguishable (P = 0.252, 0.0972, and 0.230 at 1, 2, and 3 months, respectively). Likewise, the difference in percentage change from baseline in hair counts (which normalizes to baseline values) between the shaving control and hot-wire device is close to zero at every time point (-4.9% to +4.9%) and the t-test P-values are high (0.154< P < 0.890 over all the time points in the study and 0.360 < P < 0.890 during the 1, 2, and 3 month follow-up period), indicating no detectable difference between shaving and the hot-wire. In terms of hair characteristics, no difference in hair color or hair thickness was seen between the shaving control and the hot-wire sites in the treatment or follow-up period.

CONCLUSIONS

Relative to shaving, the hot-wire (no!no!) device does not produce lessened hair density, decreased hair re-growth rate, greater duration of effect, nor induce changes in hair thickness and color. We conclude that the hot-wire device does not offer any benefit as compared to shaving.

Laser hair removal: a review

BACKGROUND

Unwanted hair growth is a common aesthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation.

OBJECTIVES

To extensively review the literature on laser hair removal pertaining to its theoretical basis, current laser and light-based devices, and their complications. Special treatment recommendations for darker skin types were considered.

MATERIALS AND METHODS

A comprehensive literature search related to the long-pulse alexandrite (755 nm), long-pulse diode (810 nm), long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG; 1,064 nm), and intense pulsed light (IPL) system, as well as newer home-use devices, was conducted.

RESULTS

The literature supports the use of the alexandrite, diode, Nd:YAG and IPL devices for long-term hair removal. Because of its longer wavelength, the Nd:YAG is the best laser system to use for pigmented skin. Further research is needed regarding the safety and efficacy of home-use devices.

CONCLUSION

Current in-office laser hair removal devices effectively provide a durable solution for unwanted hair removal.

Long-term removal of unwanted hair using light

Laser (or light) hair removal, also referred to as photoepilation, is the most commonly used laser or light-based cosmetic medical procedure. The extended theory of selective photothermolysis is the basic principle for destruction of hair follicles using light. In this type of laser application the chromophore is follicular melanin. Several types of lasers and light sources have been effective for hair reduction, including the ruby, alexandrite, diode, and neodymium:yttrium-aluminum-garnet lasers and broadband, intense pulsed light sources. This article provides a broad overview of how hair can be removed using light, with an emphasis on practical considerations.

The evaluation and treatment of hirsute women

Hirsutism in women is defined as an excess of body hair in the androgen-sensitive skin regions. The different genetic backgrounds of various populations may affect the causes of hirsutism. In fact, the most important reason for investigation is to identify those women with androgen-secreting tumors, since they require different therapy. Hirsutism may have various causes, such as polycystic ovary syndrome, enzyme defects in adrenal steroid biosynthesis, Cushing's syndrome, acromegaly, ovarian or adrenal tumors, or it may be idiopathic. In most patients, hirsutism is associated with hyperandrogenemia and the most common cause of androgen excess is polycystic ovary syndrome. Androgen-secreting tumors should be suspected when the onset and progression of hirsutism is rapid and/or when it is associated with virilization. Patients should be informed about the type and duration of therapy. The selection of drug/drugs depends on the severity of the hirsutism, associated conditions such as menstrual irregularities, systemic disorders such as diabetes mellitus, hypertension and any contraindication to possible therapeutic agents. Diane(R) 35 is the most common drug used for the suppression of ovarian androgen production. Peripheral blockade of androgen actions, by using spironolactone, finasteride or flutamide on the skin, is also effective in the treatment of hirsutism.

Mathematical modeling of the optimum pulse structure for safe and effective photo epilation using broadband pulsed light

The objective of this work is the investigation of intense pulsed light (IPL) photoepilation using Monte Carlo simulation to model the effect of the output dosimetry with millisecond exposure used by typical commercial IPL systems. The temporal pulse shape is an important parameter, which may affect the biological tissue response in terms of efficacy and adverse reactions. This study investigates the effect that IPL pulse structures, namely free discharge, square pulse, close, and spaced pulse stacking, has on hair removal. The relationship between radiant exposure distribution during the IPL pulse and chromophore heating is explored and modeled for hair follicles and the epidermis using a custom Monte Carlo computer simulation. Consistent square pulse and close pulse stacking delivery of radiant exposure across the IPL pulse is shown to generate the most efficient specific heating of the target chromophore, whilst sparing the epidermis, compared to free discharge and pulse stacking pulse delivery. Free discharge systems produced the highest epidermal temperature in the model. This study presents modeled thermal data of a hair follicle in situ, indicating that square pulse IPL technology may be the most efficient and the safest method for photoepilation. The investigation also suggests that the square pulse system design is the most efficient, as energy is not wasted during pulse exposure or lost through interpulse delay times of stacked pulses.

PACS number: 87.10.Rt

Low-fluence vs. standard fluence hair removal: a contralateral control non-inferiority study

Introduction

Laser hair removal at lower fluences, delivered under certain conditions, may retain the efficacy of high-fluence lasers while improving tolerability. We performed a pilot study comparing the efficacy, safety and tolerability of laser hair removal using traditional settings compared to lower fluences, delivered from a larger handpiece and under vacuum.

Material and methods

Fourteen healthy participants underwent 5 axillary hair removal treatments with an 800 nm diode laser at 1-month intervals, with follow-up 1 and 3 months after the 5th treatment. In all patients, one side was treated with standard parameters using a 9 × 9 mm chilled tip and gel, while the contralateral side was treated using a 22 × 35 mm vacuum-assisted handpiece at fluences up to 12 J/cm². Follow-up assessments were performed after each treatment and at each follow-up visit, and included photography and questionnaires.

Results

Eleven participants completed the study and follow-up. All experienced significant hair removal in all treated areas. At the 3-month follow-up visit, the high-fluence and low-fluence treated axillae demonstrated comparable hair reduction. Participants found the lower fluence treatments to be more tolerable. No adverse events were reported.

Conclusion

Lower fluence diode laser, delivered under conditions of vacuum and using larger spot sizes, can provide significant hair reduction.

Non polycystic ovary syndrome-related endocrine disorders associated with hirsutism

BACKGROUND

Hyperandrogenism refers to classical androgen-dependent signs such as hirsutism, acne and androgenetic alopecia. Hirsutism is the main hyperandrogenic symptom, defined as an excess of body hair in the androgen-sensitive skin regions of the women. In this review, we attempt to focus on the pathogenesis of hirsutism related to disorders other than polycystic ovary syndrome (PCOS). Also, we will discuss their clinical and biochemical features as well as therapeutic options.

DESIGN

Several original articles, meta-analysis and reviews have been screened in the field of hirsutism and hyperandrogenic disorders.

RESULTS

Current English literature including our studies suggests that PCOS is the most common cause of hirsutism. The most important purpose for investigation is to identify those women with androgen-secreting tumours because of their life-threatening potential. In approximately 1-8% of the women with hirsutism, the underlying cause is nonclassical adrenal hyperplasia because of 21-hydroxylase deficiency. Depending on ethnicity and the geographic area, idiopathic hirsutism constitutes 5-17% of the patients with hirsutism. Approximately 3% of hyperandrogenic women were observed to suffer from hyperandrogenic-insulin-resistant acanthosis nigricans syndrome. More rare causes are glucocorticoid resistance syndrome, hyperprolactinemia, acromegaly, Cushing's syndrome and some drugs. Specific causes of hirsutism such as Cushing's syndrome and adrenal/ovarian tumours should be treated specifically. In other patients, pharmacological approach is the mainstay of therapy.

CONCLUSIONS

A number of patients presenting with hirsutism and exhibiting similar features to PCOS may have other underlying diagnoses. Unlike PCOS, some of these disorders can occasionally be life threatening and require prompt diagnosis and treatment.

Comparison of hair reduction with three lasers and light sources: prospective, blinded and controlled study

OBJECTIVE

The main goal of this study was to compare the hair removal efficacy of three methods: intense pulsed light (IPL), a combination of IPL and radio frequency (RF) and diode laser (810 nm).

METHODS

Forty participants were treated within three standardized squares on lateral sites on their legs. Each of these squares was treated twice with an interval of 4-6 weeks. The fourth square was left as a control. A blinded physician counted the hairs in each square before the first treatment and 8 months after the second treatment. Immediate and delayed side effects as well as pain scores were recorded.

RESULTS

The mean hair count reduction achieved by the diode laser, IPL and IPL+RF was 49.90%, 39.16% and 47.15%, respectively. This study did not show any serious side effects and the number of side effects was minimal. The mean pain scores for the first and second treatments by diode laser, IPL and IPL+RF were 4.65 and 4.58, 2.43 and 2.53, and 3.95 and 4.03, respectively. At the end of the study, a free hair removal treatment for both legs was chosen by patients in the proportion 20 diode laser, 10 IPL and eight IPL+RF.

CONCLUSIONS

The combination of RF and optical energies proved its safety and efficacy for hair removal, which is comparable with diode lasers and approximately 20% more efficient than 'pure' IPL.