Hair removal using the long-pulsed ruby laser in children

A review of hair removal modalities in pediatric patients: Ethical and clinical considerations

Unwanted hair is a common concern among patients presenting to pediatric dermatology clinics, and parents and patients alike inquire about the safety of methods employed for elective removal. Various methods of hair removal exist with different levels of invasiveness and permanence, from simple mechanical depilation to light-based therapies. All methods of hair removal appear to be safe and generally well tolerated in children, and there are no age restrictions to any modality. In this review, we aim to address the available literature on the safety and efficacy of hair removal modalities in pediatric patients and propose guidance on how to manage requests for at-home and in-office therapies within an ethical framework.

Laser and light therapy for pediatric hair removal: a systematic review

Hair removal with lasers and intense pulsed light (IPL) is considered safe. However, data on the efficacy and safety of these procedures specifically in the pediatric population remain sparse. To determine the efficacy and safety of lasers and IPL for hair reduction in children and adolescents, a systematic review was conducted of original studies evaluating hair removal with lasers or IPL in patients aged less than 18 years. Primary outcome measures were efficacy and safety of treatment. The literature review yielded 2 retrospective cohort studies and 11 case reports/case series including a total of 71 patients aged 9 months to 17 years. Diagnoses ranged from localized lumbosacral to generalized hypertrichosis. Six treatment modalities were evaluated: alexandrite, Nd:YAG, Q-switched Nd:YAG, ruby, and diode lasers and IPL. Only one of the cohort studies (n = 28), using the ruby laser, provided efficacy data. The results showed a 63% hair loss in 89% of patients after completion of treatment, although partial regrowth was evident during 6 to 32 weeks of follow-up. Most of the case reports and case series (10/11) reported significant hair reduction following laser and IPL treatments. None of the patients experienced scarring or dyspigmentation. Some kind of pain management was necessary in 65% of patients; 25% required general anesthesia. On the basis of the limited available data which consisted primary of case reports and case series, lasers and IPL might be effective for pediatric hair reduction. Recurrence following treatment may be higher in children than adults, and pain control may be a limiting factor.

When Is Teenage Plastic Surgery versus Cosmetic Surgery Okay? Reality versus Hype: A Systematic Review

Plastic surgery in teenagers has become popular in past decades because of an increase in self-awareness and desire to "fit in" with their peers. In 2016, over 229,551 cosmetic procedures were performed in patients who are younger than 19 years. The trend of plastic surgery in adolescents is increasing, and it is important for plastic surgeons to perform safe and appropriate procedures in this group. To this date, there is a myriad of literature on the psychological and ethical issues concerning plastic surgery in teenagers. However, studies regarding the safety of performing plastic surgery in this population are scarce. The rationale for this article is to study this issue in depth by means of a systematic review. The authors discuss the current indications, safety, patient satisfaction, and ethical considerations of teenage plastic surgery and make recommendations for future studies on this important area.

Congenital Generalized Hypertrichosis, Gingival Hyperplasia, a Coarse Facies with Constriction Bands: A Rare Association

Congenital generalized hypertrichosis terminalis is a rare primary hypertrichotic condition, of unknown etiology presenting in the pediatric population. Though benign in nature, there is considerable psychosocial trauma attached to this, owing to the cosmetic disfigurement it produces. The association of gingival fibromatosis and a coarse facies could further worsen the cosmesis. Thus, a multidisciplinary approach involving a psychologist, a dentist apart from the dermatologist would be mandatory. We present this rare syndrome with the purpose of getting a better insight regarding the inheritance, the clinical features and the best available treatment modalities, especially the modern and novel techniques of hair removal that could be utilized to manage such individuals.

Localized hypertrichosis in a pediatric patient--what is the mechanism for excess hair growth?

Localized hypertrichosis is an uncommon complaint among pediatric dermatology patients. We highlight an instance of localized hypertrichosis due to an underlying diffuse neurofibroma in a patient with known neurofibromatosis 1. The classification and possible underlying pathogenic mechanisms of localized hypertrichosis in pediatric patients is discussed.

Laser surgery: an approach to the pediatric patient

Revolutionary advances in laser research and technology have led to expanded dermatologic laser applications. With the wide range of lasers now available, a large spectrum of skin conditions in the pediatric population can be successfully treated or, in some cases, completely eradicated. Laser treatment of the pediatric population poses a unique challenge for the clinician on a variety of levels. Physically, the composition of many vascular and pigmented lesions changes as children age making them more resistant to laser therapy. Thus, in many cases, treating lesions at an early age has resulted in clearing in fewer sessions and with decreased complications. Mechanically, lasers and laser settings used for the treatment of adult lesions may have to be adjusted for the smaller vessels and the unpredictable nature of scarring with children's skin. For vascular lesions, the pulsed dye laser is considered the laser of choice for its efficacy and low-risk profile, whereas the Q-switched, pigment-specific lasers are ideal for most childhood pigmented lesions, allowing for single pigment cell destruction. Other conditions such as acne and acne scars, psoriasis, keloids, warts and hypertrichosis that traditionally have been treated with a variety of modalities are now being managed safely with laser surgery. Other issues specific to the pediatric population include the determination of suitable anesthesia, the provision of size-appropriate safety equipment, and the assessment and management of patient and parent anxiety. The use of lasers specifically designed for structural differences in pediatric lesions and the recognition of emotional issues surrounding a young patient during laser surgery are critical components of successful treatment.

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should be familiar with the mechanism of laser technology, current trends in the use of lasers for skin lesions in the pediatric population, and the issues specific to treating a patient with laser surgery.

Patient satisfaction with laser hair removal

BACKGROUND

Laser hair removal (LHR) is a widely used treatment for unwanted hair.

AIM

To determine patient satisfaction with LHR.

METHODS

The clinic offered LHR by long pulse ruby, alexandrite and Nd:YAG. Patients attending the LHR clinic completed a patient satisfaction questionnaire. Satisfaction with LHR treatment was recorded on a linear analogue scale (LAS 0 = laser very much worse than alternative method; 10 = laser very much better than the alternative method).

RESULTS

In terms of hair removal, 71% of patients were satisfied with their treatment. Laser treatment compared favourably with electrolysis and waxing. LHR scored 8.6 when compared with electrolysis and 7.7 when compared with waxing. During LHR treatments, 61% of patients used fewer ancillary methods than before. Most patients would recommend LHR to other persons with unwanted hair.

CONCLUSIONS

Most patients were satisfied with LHR.