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Methods to Overcome Poor Responses and Challenges of Laser Hair Removal in Dark Skin

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Methods to Overcome Poor Responses and Challenges of Laser Hair Removal in Dark Skin [Downloaded free from http://www.ijdvl.com on Saturday, January 5, 2019, IP: 117.212.88.78] Symposium - Lasers Methods to overcome poor responses and challenges of laser hair removal in dark skin Shehnaz Zulfikar Arsiwala, Imran M. Majid1 Renewderm Centre, Saifee Hospital, Prince Aly Khan Hospital, Mumbai, Maharashtra, 1Cutis Institute of Dermatology, Srinagar, Jammu and Kashmir, India Abstract Correspondence: Dr. Shehnaz Zulfikar Arsiwala, Conventional and advance technologies are available for laser hair removal. Complete and permanent Renewderm Centre, hair reduction is not yet possible by treatment with lasers. Ideal patient for any conventional laser hair New Mazgaon Co‑op Society, removal treatment is one who has thick, dark terminal hair, light skin and normal hormonal status. Factors A Wing 3rd Floor, Nesbit Road, that contribute to variable outcomes in laser hair removal can be broadly divided into patient related ones Mazgaon, Mumbai, and the technology related ones. Skin type, hair color, thickness and density, degree of tan, hormonal Maharashtra, India. E‑mail: [email protected] dysfunction etc., constitute the patient related factors. The wavelength, fluence, spot size and pulse duration of the laser system are the technology related factors. There are some patients who respond variably, unpredictably or poorly to laser hair removal despite ensuring that indication for treatment is appropriate with adequate parameters of the laser system. This article reviews various patient related and technology related factors which lead to variable‑to‑poor outcomes in laser hair removal; and various challenges and limitations of laser hair removal technology in patients with dark skin types. Key words: Dark skin, laser hair removal, poor outcomes Introduction wherein there is selective absorption of wavelength by the Demand for laser hair removal has increased exponentially chromophore.1 Evidence indicates that complete, total and during the last decade. Traditional methods of hair removal persistent hair removal with lasers cannot be achieved.1 There such as threading, plucking and waxing have largely been is evidence which indicates that lasers induce complete but replaced by interventions using laser and light sources as temporary hair loss, followed by partial, permanent hair the latter methods are substantially superior in achieving reduction. Lasers produce significant delay in hair regrowth long term hair reduction. Laser hair removal is said to be after treatment, which can last from weeks to months. After permanent when there is a stable decrease in the number laser treatment, the terminal hairs are replaced by fine vellus of terminal hair for a period longer than the complete hair hairs. Efficacy is improved when treatment is repeated.1,2 growth cycle at a given site after treatment. 1 The target chromophore in laser hair reduction is melanin. Laser energy Photothermal, photomechanical and photochemical is absorbed by melanin in the hair follicle. Hair bulb, bulge mechanisms contribute to laser hair removal. Photothermal and papilla are heated consequent to the absorption of laser energy of laser causes a rise in temperature in hair bulb energy. Energy is delivered to the target in lesser time than and bulge causing thermal destruction of hair follicle. required for heat diffusion to the surrounding tissue which Photomechanical energy initiates shock wave formation and remains unaffected. Simultaneous cooling of the epidermis photochemical energy is generated by free radicals.2 to protect it will achieve selective photothermolysis This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, Access this article online which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under Quick Response Code: Website: the identical terms. www.ijdvl.com For reprints contact: [email protected] DOI: 10.4103/ijdvl.IJDVL_1103_16 How to cite this article: Arsiwala SZ, Majid IM. Methods to overcome poor responses and challenges of laser hair removal in dark skin. PMID: Indian J Dermatol Venereol Leprol 2019;85:3-9. *** Received: December, 2016. Accepted: January, 2018. © 2018 Indian Journal of Dermatology, Venereology and Leprology | Published by Wolters Kluwer - Medknow 3 [Downloaded free from http://www.ijdvl.com on Saturday, January 5, 2019, IP: 117.212.88.78] Arsiwala and Majid Poor response and challenges of laser hair removal Wavelengths in the range of 600–1200 nm produced by subjects and clinicians.10,11 Safety and efficacy of laser hair conventional systems such as ruby (694 nm), long‑pulsed removal is compromised in patients with darker skin types alexandrite (755 nm), long‑pulsed diode (810 nm), long‑pulsed with short‑pulse durations and high fluences.6,12 Nd: YAG (1064 nm) and intense‑pulsed light can achieve this. Radiofrequency also injures hair photothermally. Q‑switched Tanning of skin Nd: YAG laser (1064 nm), with or without the addition of a Complications like first or second degree epidermal topical carbon suspension, destroys hair thermomechanically.3,4 burns from short wavelengths exist. Some physicians are compelled to use lower fluences to prevent burns at the cost New techniques include low‑fluence laser hair removal applied of efficacy. Reports of complications from short wavelengths in motion with a high repetition rate to achieve progressive in the form of first‑ or second‑degree epidermal burns result photothermolysis. Repeated and fast emission of pulses of low in use of suboptimal laser fluence and reduces efficacy of the 3,13 energy progressively heats the chromophore to temperatures procedure. This is a limitation of laser hair removal in dark of 45–50° over a period of time and safeguards the epidermis skin types as hair reduction can be achieved but at the cost of from overheating as opposed to a sudden rise in temperature to epidermal burns. 65° in conventional systems.5 There are various factors related to patient and technology which could result in variable, Hair type and color Terminal hairs, not vellus hairs, are considered suited for unpredictable or poor responses to laser hair removal in spite laser hair reduction as they absorb laser energy more. Good of ensuring appropriate indications and adequate parameters of response to laser hair reduction occurs when the targeted laser use. These are reviewed in this article. hair has a high concentration of chromophores. Thin fine hairs have less pigment, and hence, are poor choices for Factors that contribute to variable outcomes in laser hair laser hair reduction even with best fluences and multiple removal can be broadly divided into patient factors and treatments compared to thick terminal hairs. Hairs less than technological factors [Table 1]. 30 microns in diameter are not ideal for laser hair removal. When vellus or thin hairs are treated, responses may be poor Patient Related Factors due to relatively less chromophore in them. This is true when An ideal patient for conventional laser hair removal is one who treating areas such as upper lip where chromophore in vellus has thick dark terminal hairs, light skin and normal hormonal hairs is less for laser wavelength absorption.6,14,15 status.1 Patient selection should not be compromised during laser hair removal as these can decrease response to treatment. Pigmentation of hair These are explained in the following sections. Melanin is the chromophore for laser absorption. Persons with black, brown, red, dark or blonde hairs achieve long‑lasting Skin type results but those with light blonde or white hairs experience only Dark skin types necessitate that sufficient caution is taken for temporary reduction for up to 12 weeks. However, considerable the safe application of a laser hair removal by any wavelength. variations in treatment results are often seen among patients Clinical studies show that in skin types 4‑6, there is increased with dark hair.6 Most patients with brown or black hair obtain amount of epidermal melanin which acts as a competing chromophore to melanin in hair bulb and shaft. This leads to a higher frequency of adverse effects. To minimize these Table 1: Factors that contribute to variable outcomes in laser adverse reactions, most clinicians use less fluence which can hair removal reduce efficacy and response in laser hair removal. Patient factors Technologic factors Skin type System specifications The long‑pulsed Nd: YAG laser remains the recommended Degree of tan Wavelength Hair type and color Spot size choice in very dark individuals and tanned patients due to Hair regrowth cycle Fluence its longer wavelength. Safety of patients with type 5‑6 skin Hormonal influences Pulse duration is a challenge for laser hair removal due to high density of Optimal endpoint Vacuum‑assisted technology competing chromophore in the epidermis.6 A wavelength Paradoxical hypertrichosis In motion technology Operator dependent factors which is less absorbed by melanin maybe less effective clinically as target chromophore for hair removal laser is 7,8 melanin in hair bulb and bulge. Table 2: Factors influencing outcome in laser hair reduction in between sessions A study reported that diode laser was better than the Variations in degree of tan alexandrite laser because emission from the former could Variations in diameter of hair‑variable chromophore density penetrate deeper into the dermis.9 Reduction in hair
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