Diode Laser Hair Removal in Patients Undergoing Isotretinoin Therapy

BACKGROUND: It is generally believed that any intervention in skin while on isotretinoin or within 6 months after the treatment can lead to prolonged healing and scarring. OBJECTIVE: The objective was to evaluate the side effects of laser hair removal in patients undergoing isotretinoin treatment. METHODS: Seven female patients undergoing isotretinoin therapy for acne were treated with a diode laser with a wavelength of 810 nm, a contact-cooling device, and a variable pulse width of 50 to 1000 ms. All volunteers received first treatment in the axillary or bikini area at 21 J/cm(2) (80 W) and the second treatment was done in the same area at 24 J/cm(2) (90 W). Six volunteers received additional treatments of chin area with a fluence of 21 or 24 J/cm(2). All volunteers were evaluated and photographed 1 week and 1 month after each treatment and degree of erythema, pigmentary change, vesiculation, swelling, and scarring was documented. RESULTS: There was no erythema, pigmentary change, swelling, or scarring at any follow up visits. One volunteer presented with a bulla 1 week after second treatment, which was resolved at 1-month follow-up. All volunteers were satisfied with the degree of hair removal with two treatments. CONCLUSION: This limited study suggests that diode laser hair removal is safe in patients undergoing isotretinoin therapy.     

The Use of a New Diode Laser for Hair Removal

BACKGROUND: Diode and long-pulse 1064 Nd:YAG lasers, because of their long wavelengths and extended pulse durations, have gained popularity over the last several years for photoepilation in individuals with dark skin phenotypes. OBJECTIVE: To analyze the clinical efficacy and histologic features of a new 810-nm diode laser in the treatment of unwanted hair in individuals with Fitzpatrick skin types II-IV. METHODS: Twenty-four female subjects (mean age, 33; range, 17-53) were treated three times at monthly intervals with the MeDioStara diode laser (Zeiss-Meditech, Jenna, Germany): wavelength 810 nm, spot size 12 mm, pulse duration 50 msec; fluence 25-35 J. Patients had skin types II-IV and light to dark brown hair. Hair counts were carried out using handheld magnifiers at baseline and at months 1, 2, 3, and 6. Six individuals had biopsies taken after treatment and at 3 and 6 months. RESULTS: A mean hair removal efficiency of 74% and 79% was noted at 3 and 6 months, respectively, and was best in those individuals with skin type III. Hair counts after treatment and at last follow-up were significantly lower when compared with the baseline counts (P<0.0001). Histologic analysis revealed a range from early catagen induction to complete follicular destruction. CONCLUSIONS: This study supports the clinical photoepilatory efficiency of a new 810-nm diode laser in producing 70% clinical hair removal efficiency at 6 months. Histopathologic evaluation suggests that this decrease in hair counts is probably secondary to heat trauma to the follicular epithelium, resulting in complete follicular destruction and stopping of anagen phase.     

半导体激光治疗先天性脊柱裂伴腰骶部多毛症

目的：评价800nm半导体激光治疗先天性脊柱裂伴腰骶部多毛症的脱毛效果。方法：应用波长为800nm的半导体激光对6例先天性脊柱裂伴发腰骶部多余毛发进行治疗。4～6周治疗1次，4次为1个疗程。肤色较黑或毛发较粗硬的患者，脉宽设置100ms或400ms,肤色较浅或毛发较细软的患者，脉宽设置30ms。一般能量密度从28～30J／cm^开始，最高能量密度可达40J／cm^2。随访6个月观察不良反应。结果：经4次治疗后，局部毛发基本完全脱落。随访6个月，仅2例患者脱毛部位毛发再生，再生毛发面积不超过原有脱毛面积的10％，且再生毛发较治疗前变得细软，生长延迟；无炎症后色素沉着、色素脱失、紫癜、瘢痕等并发症。结论：800nm半导体激光治疗先天性脊柱裂伴发的腰骶部多毛症安全有效、并发症少，是一种比较理想的脱毛方法。     

Laser Hair Removal

BACKGROUND: The mechanism and permanence of laser-assisted hair removal remains a formidable task in the medical community. OBJECTIVE: The purpose of this study was to determine the safety and long-term efficacy of the long-pulsed or normal mode alexandrite infrared laser for hair depilation. METHODS: Beginning in October 1996, a total of 31 anatomic sites on 22 patients ranging in age from 25 to 59 years (mean 42 years) were evaluated to assess hair removal. Treatment sites included 17 upper lips, 9 legs, 2 backs, and 3 bikini regions. Eligible patients were of Fitzpatrick skin types I-III. Patients were treated using the long-pulsed alexandrite infrared laser at 755 nm, single-pulse technique, 10 mm spot size, 10% overlap, pulse durations of 5, 10, and 20 msec, and a fluence of 20 J/cm2. Subjective patient improvement and objective, blinded graded improvement was assessed at 1, 2, 3, and 6 months. RESULTS: Objective blinded grading at 6 months revealed that hair reduction varied both with the pulse duration and anatomic location. Maximum reductions observed were 40%, 56%, 50%, and 15% for the lip, leg, back, and bikini areas, respectively. Upper lip hair reduction increased from 40% to 54% at 6 months when a second treatment was performed 8 weeks after the initial treatment. CONCLUSION: The long-pulsed alexandrite laser is safe and effective in reducing hair growth. Treatment efficacy varies with the anatomic location, pulse duration, and number of treatments. A single-pulse technique utilizing a 10 msec pulse duration at 20 J/cm2 produced the greatest hair reduction. No permanent adverse effects occurred on skin types I-III at the parameters tested.     

Laser Hair Removal with Alexandrite versus Diode Laser Using Four Treatment Sessions: 1-Year Results

BACKGROUND: Laser hair removal is the treatment of choice for hypertrichosis. The two most commonly used hair removal lasers are compared. OBJECTIVE: To present the results of a comparative study examining the role of wavelength, fluence, spot size, pulse width, and cooling systems on long-term results after a series of four laser hair removal treatments using the 755 nm alexandrite and 800-810 nm diode lasers. METHODS: The axillae of 15 untanned, type I-V patients were treated side by side four times at 4- to 6-week intervals with a 755 nm, 3-msec pulse width, cryogen spray-equipped alexandrite laser and an 800 nm, variable pulse width, cooled sapphire window-equipped diode laser. Each patient was pretested and treated with the maximum fluence tolerated at the largest spot size available for each laser (12 mm round/113 mm2 for the alexandrite and 9 mm for the diode). RESULTS: Evaluations were done at 3, 6, 9, and 12 months after the last treatment. Twelve-month results with the alexandrite and diode lasers achieved 85% versus 84% hair reduction. The fact that tan avoidance was strictly followed permitted the use of relatively high fluences (25-30+ J/cm(2)) even in type IV patients. For most patients, four treatment sessions using high fluences (30-40 J/cm(2)) with relatively large spot sizes (12 mm round for the 755 nm alexandrite and 9 mm for the 800 nm diode) resulted in 12-month hair reductions in the 90% range. CONCLUSION: Both the alexandrite and diode lasers in this 12-month study produced excellent long-term hair reductions.     

Hair Growth Induced by Diode Laser Treatment

BACKGROUND: Although hair reduction by long-pulsed red and infrared lasers and light sources is generally quite effective, paradoxical hair growth has rarely been observed following treatment. OBJECTIVE: To report a case of thick hair growth following 810 nm diode laser treatment and its subsequent treatment. METHODS. A 24-year-old man who had previously had laser hair reduction on his posterior neck was treated to a test area on his upper back. RESULTS: Thick terminal hair developed in the treated area subsequent to laser treatment. Further treatment of this area removed the terminal hair but resulted in terminal hair growth in an annular distribution surrounding the treatment site. CONCLUSIONS: Diode laser treatment rarely stimulates terminal hair growth. This phenomenon should be studied to better understand hair growth cycles and to help develop more effective treatments for hair loss and hair growth.     

Hair Removal Using an 810 nm Gallium Aluminum Arsenide Semiconductor Diode Laser: A Preliminary Study

BACKGROUND: Laser hair removal is a popular treatment method for removing unwanted hair. Several laser systems are available for laser hair removal. The gallium aluminum arsenide semiconductor diode (GAASD) laser is one of the newer laser modalities to be studied. OBJECTIVE: To evaluate the efficacy of the GAASD laser system in removing unwanted hair. METHODS: Twenty-six patients with brown or black hair growth were treated with the GAASD laser at fluences of 20-80 J/cm2. Hair regrowth was measured 4 weeks after the first treatment, 4 weeks after the second treatment, 4 weeks after the third treatment, and 4 weeks, 8 weeks, and 8 months after the fourth treatment. CONCLUSION: GAASD laser treatment resulted in hair growth delay in all treated regions. Repeated laser treatments did not produce an increased number of vellus hairs. The percentage of hair reduction fluctuated between 5% and 13% with the second or third treatment averaging the highest percent reduction. In all cases, the percentage of hair reduction of the treatment sites evaluated at 8 months after the fourth treatment was less than both the second and third treatments (highest average percent reduction) and the fourth (last) treatment.     

Hair Reduction Using a Scanning 800 nm Diode Laser

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.     

Laser Hair Removal: Comparison of Long-Pulsed Nd:YAG, Long-Pulsed Alexandrite, and Long-Pulsed Diode Lasers

Background. Advances in laser technology over the past several years have led to the development of numerous lasers for the treatment of unwanted hair. Laser wavelength is a key factor influencing treatment efficacy and complication rates.
Objective. To compare the efficacy and safety of laser hair removal using three different laser systems.
Methods. A retrospective study of 805 consecutive laser-assisted hair removal treatments, conducted on 75 patients by means of either a long-pulsed Nd:YAG, a long-pulsed alexandrite, or a long-pulsed diode laser is reported. All patients were evaluated at least 3 months after the last treatment, and their present conditions were compared with the 1st-day photographs.
Results. The mean hair reduction was 42.4%, 65.6%, and 46.9% in Nd:YAG, alexandrite, and diode lasers, respectively. When the number of treatment sessions was taken into account, the efficacy of alexandrite and diode lasers was not significantly different, whereas both systems were more efficacious than Nd:YAG. Neither of the laser systems showed better results for a particular skin type. The occurrence of side effects was not significantly different between three laser systems.
Conclusion. Both long-pulsed alexandrite and long-pulsed diode laser systems are effective in the treatment of unwanted hair, and they are more efficacious than Nd:YAG laser.     

The Effect of Different Spot Sizes on the Efficacy of Hair Removal Using a Long-Pulsed Diode Laser

BACKGROUND: In the last years several lasers have proven their efficacy for hair removal. However, little is known about the efficacy of varying the spot size with those lasers. OBJECTIVE: To evaluate the long-term efficacy of hair removal using a diode laser with different spot sizes. METHODS: A long-pulsed diode laser (2 x 60 msec) was used. The spot size was 8 mm, 12 mm, or 14 mm. Twenty consenting volunteers were treated three times at regular intervals of 3 weeks. The ratio of the number of hairs in the treated area to an adjacent area left untreated (control) was referred to as regrowth. RESULTS: One month after laser treatment, regrowth was 23% (8 mm), 12% (12 mm), and 13% (14 mm). After 3 months regrowth was 67% (8 mm), 54% (12 mm), and 55% (14 mm). Fifteen months after treatment 4 of 16 volunteers had a regrowth rate of less than 25%. CONCLUSION: The results provide evidence for an effective and long-lasting growth delay of hairs using the long-pulsed diode laser. The use of large spot sizes improved the growth delay of hairs measured 1 month after treatment.     

Solar-Induced Postinflammatory Hyperpigmentation after Laser Hair Removal

BACKGROUND: Postinflammatory hyperpigmentation (PIHP) is a frequently encountered problem in many cosmetic procedures. The treatment of PIHP is difficult and remains a challenge. OBJECTIVE: To treat a patient who developed multiple hyperpigmented macules on her thighs due to sun exposure after treatment of unwanted hair using a normal-mode ruby pulse laser. METHODS: The patient was treated daily with tretinoin (Retin A) 0.1% cream, triamcinolone 0.1% cream, and hydroquinone 4% cream with sunscreen (Solaquin forte), and was to avoid sun exposure. Several sites received monthly treatment of 40% trichloroacetic acid (TCA). The degree of clinical improvement of the hyperpigmentation was assessed by both the physician and the patient. RESULTS: Cosmetic results were fair. The amount of hair in her thighs was reduced but the PIHP responded only slightly to therapy. CONCLUSION: To our knowledge this is the first case of solar-induced PIHP following laser hair removal. The treatment of PIHP is difficult because there are few therapeutic options that are consistently successful. Avoidance of exposure to ultraviolet light should be emphasized to all patients prior to laser therapy. We demonstrated that serial TCA peels provided an additional benefit compared to medical treatment.     

Pigmentary Changes After Alexandrite Laser Hair Removal

BACKGROUND: Postinflammatory pigmentary changes are a frequently encountered problem with numerous dermatologic procedures. Limited literature is available that documents this complication with laser hair removal. OBJECTIVE: It is important for all physicians performing laser hair removal to be aware of this potential complication. We present our experience with postinflammatory pigmentary change and discuss some potential etiologic factors. METHODS: Seven patients who experienced postinflammatory complications after alexandrite laser hair removal are presented. These are all the patients who developed this complication in our office over the past 2.5 years. RESULTS: The patients who we describe in this article all developed a similar pattern of initial hyperpigmented rings, later developing into a thin wafer-like crust followed by hypopigmentation with gradual return to their normal skin color. CONCLUSION: In general, the alexandrite laser is both safe and effective for hair removal in patients of varying skin types. Complication rates will increase as skin pigment increases and as the power used increases. However, even in light-skinned individuals without recent pretreatment or posttreatment sun exposure, with proper treatment parameters, complications, and side effects can arise. We have found this to be especially true when treating areas other than the face.     

Comparison of Alexandrite Laser and Electrolysis for Hair Removal

BACKGROUND: Different techniques have been used for hair removal. Electrolytic epilation is a widely accepted method for this purpose. Recently laser hair removal was introduced. OBJECTIVE: To evaluate and compare the effectiveness of long-pulse alexandrite laser hair removal with electrolytic epilation. METHODS: Twenty-four areas of unwanted axillar hair in 12 patients were included in the study. The right axillar area of the patients was treated by electrolysis with an intensity of 4-8 mA, and the left area was treated with long-pulse alexandrite laser with fluences between 30 and 50 J/cm2. Electrolysis was performed four times at 3-week intervals, and laser treatment was performed three times at 4-week intervals. Before each session, the hairs in a 4 cm2 area centered in the axilla were counted. The last evaluation was done 6 months after the initial treatment. The pain, time, and cost of each procedure are compared. RESULTS: The average clearance rate of the hairs was 74% by laser and 35% by electrolysis 6 months after the initial treatment. CONCLUSION: Alexandrite laser hair removal is a more reliable and practical solution than electrolysis. Laser hair removal is more expensive than electrolysis, but is 60 times faster and less painful than electrolysis; also fewer sessions are needed with the laser with better results.     

An In Vivo Study Comparing the Efficacy and Complications of Diode Laser and Long-Pulsed Nd:YAG Laser in Hair Removal in Chinese Patients

BACKGROUND: Lasers with long wavelengths are less well absorbed by melanin and are considered to be particularly suitable for hair removal in dark-skinned patients. OBJECTIVE: To compare the efficacy and complications of 800 nm diode and long-pulsed 1064 nm Nd:YAG lasers in laser-assisted hair removal in Chinese patients. METHODS: Fifteen women had hair removal treatments (13 axillae and 2 legs) with diode laser on one side and Nd:YAG laser on the other. They were followed up for 36 weeks. Subjective assessments included the degree of immediate pain and the degree of hair regrowth. Clinical photographs were taken for evaluation by two independent observers to assess complications and the degree of hair regrowth. RESULTS: Long-pulsed Nd:YAG laser was found to be significantly associated with a greater degree of immediate pain after laser surgery (P =.0001, independent sample t-test) and also had a longer laser time (P =.0001, independent sample t-test). Besides transit adverse effects such as erythema and perifollicular edema, only one patient developed hypopigmentation at week 6 which resolved by week 36. Although regrowth rates were low at week 6 (subjective rates were 23% and 19% for Nd:YAG and diode laser, respectively), most patients had significant regrowth at week 36 (subjective regrowth rate 91% for both long-pulsed Nd:YAG and diode lasers). CONCLUSION: Diode 800 nm and Nd:YAG 1064 nm lasers are safe in laser-assisted hair removal in Chinese patients, and besides immediate pain, there was no other significant adverse effect. Most patients experienced regrowth 36 weeks after a single treatment. Further study is necessary to determine the long-term clinical efficacy and complications of laser-assisted hair removal with these systems in dark-skinned patients.     

Hair Removal Using a 5-msec Long-Pulsed Ruby Laser

BACKGROUND: Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal exist, with laser hair removal rapidly becoming the most widely used modality. OBJECTIVES: Our objective was to evaluate the efficacy and side effects of a long-pulsed ruby laser for epilation in patients with varying skin types and hair color 6 weeks and 6 months after treatment. METHODS: Seventy-four patients received one to four treatments with a long-pulsed ruby laser (694 nm, 5-msec pulse length, 6 mm spot size, 17.5-32 J/cm2) in different body areas. RESULTS: After a mean number of treatments of 1.98 (range 1-4) the mean clearance was 51-75% after 6 weeks and less than 25% after 6 months. A lower percentage of hair regrowth was observed in the facial region than on the trunk or legs and in dark hair compared to blond hair. CONCLUSION: Laser epilation provides a quick and relatively comfortable, but nonpermanent modality for hair removal with few side effects.     

Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite Laser

BACKGROUND: Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. OBJECTIVE: To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I-V. METHODS: Eighty-nine untanned patients with skin types I-V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4-6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10-15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm(2), a spot size of 12 mm was used for fluences of 35-40 J/cm(2), and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm(2). Fluences ranging from 20 to 50 J/cm(2) (mean fluence 36 J/cm(2)) were used. RESULTS: The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm(2) (35-50 J/cm(2)) and a 10-12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm(2) (30-40 J/cm2) and a 12-15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm(2) (25-40 J/cm(2)) and a 12-15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25-35 J/cm(2)) and a 12-15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm(2) (20-25 J/cm(2)) and a 12-15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. CONCLUSION: The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I-V. The best results are achieved in untanned patients with skin types I-IV.     

Concomitant Therapy of Oral Isotretinoin with Multiplex Pulsed Dye Laser and Nd: YAG Laser for Acne

ObjectiveTo evaluate concomitant therapy of oral isotretinoin with multiplex pulsed dye laser and Nd:YAG laser.MethodsA retrospective chart review of patients who received treatment of oral isotretinoin and non-ablative laser therapy to treat acne vulgaris at a single outpatient dermatology clinic site in Ontario, Canada between 2009 and 2017. Results187 patients were included, consisting of 45.5 percent males (n=85) and 54.5 percent females (n=102) with a mean age of 21.4 years. 31.6 percent (n=59) of patients reported experiencing side effects from concomitant isotretinoin and NAL therapy, the most common being eczema (n=14), erythema (n=11), significant dry skin/lips/eyes (n=8), flushing (n=6), and bruising (n=6). 99.2 percent of patients achieved clear or almost clear at treatment completion. Of those who expressed satisfaction, 65.2 percent (n=122) reported being satisfied with the treatment and the remaining patients did not report satisfaction nor dissatisfaction.Limitations Limitations exist mainly due to the absence of standardized lesion counts and a comparator cohort. Thus, it is not possible to comment on whether the combination of isotretinoin and NAL is more efficacious that either treatment alone.ConclusionConcomitant use of isotretinoin and non-ablative laser therapy is a safe and effective treatment option for acne vulgaris that provides patient satisfaction.     

Evaluation of a New Super-Long-Pulsed 810 nm Diode Laser for the Removal of Unwanted Hair: The Concept of Thermal Damage Time

BACKGROUND: Laser hair removal is based on the dual concepts of selective photothermolysis and thermal relaxation time. In most laser hair removal systems, light with emitted pulse durations of 2-50 msec targets hair follicles. A novel concept of laser hair removal uses the thermal damage time rather than the thermal relaxation time of the hair follicle. The follicle's thermal damage time is the amount of time required for diffusion of delivered laser energy from the treated hair to follicular-associated hair stem cells. This can range from 170 to 1000 msec. OBJECTIVE: To investigate the theory of thermal damage time, we performed a pilot study to evaluate the clinical efficacy and side effect profile of a modified 810 nm diode laser device operating in a super-long-pulse mode (200-1000 msec). METHODS: Ten female subjects with Fitzpatrick skin types I-VI received either one or two laser treatments at eight test sites. Super-long pulse durations of 200-1000 msec were evaluated with delivered fluences ranging from 23 to 115 J/cm2. Subjects were followed for 6 months after the first treatment. Subjects were evaluated for hair removal efficiency, optimal pulse duration and delivered fluence, and associated complication rate. RESULTS: The clinical results show that safe hair removal in all skin types can be accomplished with an 810 nm diode laser delivering super-long pulse durations. Pain and complications were greatest at the highest pulse duration (1000 msec) and the highest fluence (115 J/cm2). Optimal hair reduction at 6 months (31%) was achieved at a thermal diffusion time of 400 msec (46 J/cm2). CONCLUSION: The super-long pulsed 810 nm diode laser can safely remove unwanted hair in a full variety of skin types. Pain and increased risk of complications may preclude the use of the laser at very high fluences and pulse duration in the range of 1000 msec.