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Hypertricosis Not Uncommon After Laser Removal of Facial Hair

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Hypertricosis Not Uncommon After Laser Removal of Facial Hair 48 Dermatologic Surgery S KIN & ALLERGY N EWS • June 2007 Hypertricosis Not Uncommon For Hidradenitis After Laser Removal of Facial Hair Suppurativa, Hair Removal Aids Tx ARTICLES BY laser or intense pulsed light. They re- Several dermatologists who heard MITCHEL L. ZOLER ceived 3-23 treatments. the report at the meeting said that G RAPEVINE, TEX — Hair removal by intense Philadelphia Bureau At follow-up, an average of 10% of their own anecdotal experience con- pulsed light is a useful adjunctive treatment for re- the women had increased facial hair, firmed Dr. Willey’s report. fractory hidradenitis suppurativa, based on experi- G RAPEVINE, TEX. — Facial-hair 8% had no change, 78% had reduced “You can predict which women will ence with 10 patients at one center. removal with laser energy can back- hair growth, and 3% had complete have this. They all have fine, almost Five of the treated patients had clear improvement fire and trigger hypertrichosis if the hair removal. The remaining 1% had downy hair on dark skin that is type in their clinical status after 3-4 hair-removal treat- regimen is not optimized, Dr. An- incomplete information and weren’t III or higher,” said Dr. Jeffrey S. Dover, ments, with reduced or resolved lesions in the treat- drea Willey said at the annual meet- included in the analysis. a dermatologist in private practice in ed area. The remaining five patients had improvement ing of the American Society for Laser Women with hypertrichosis after Chestnut Hill, Mass. after four to eight treatments, Dr. Agneta Troilius said Medicine and Surgery. treatment had the extra hair pre- “I don’t treat thin, wispy hairs on at the annual meeting of the American Society of In a review of more than 500 dominantly in their beard area. All of the neck because the likelihood of hy- Lasers in Medicine and Surgery. The treatment also women who underwent photoepila- the affected women had prominent pertrichosis is so high,” added Dr. E. resulted in less scarring than usually occurs when tion, it was found that paradoxical vellus hair before treatment, noted Victor Ross, director of the laser and hidradenitis suppurativa (HS) lesions resolve. hair stimulation occurred in about Dr. Willey. cosmetic dermatology unit at Scripps “Hair removal is one element of treatment” for a 10%, much more common than pre- No apparent link between skin Clinic in San Diego. ■ disease that affects as many as 4% of women, said Dr. viously reported. type and hair growth was found. Troilius, head of the laser and vascular anomaly sec- A reliable way to prevent this out- Of the 57 women with hair Results of Laser tion of the department of dermatology at Lund Uni- come is to cool the surrounding skin growth, 16 had polycystic ovary versity in Malmö, Sweden. with ice packs during laser treat- syndrome or irregular menses. Facial-Hair Removal The series included women aged 21-45 years with ment, along with using the maxi- The cause of paradoxical hy- 1% skin type II or III who had active HS for several years mum tolerated laser fluence and em- pertrichosis in this setting is not Incomplete 3% and had lesions that had affected their social lives. ploying a double-pass technique, said clear, and several mechanisms 10% information Complete Treatment was with an intense pulsed light (IPL) de- Dr. Willey, who is a dermatologist at probably play a role, she said. Increased hair removal vice, the Ellipse model made by Danish Dermatologic facial hair Oregon Health and Science Univer- One possibility is that sub- 8% Development, using the hair applicator to deliver sity, Portland. therapeutic laser energy injures No change 645- to 950-nm light. Treatment was with a fluence of She and her associates reviewed hair follicles, thus stimulating 17-19 J/cm2, delivered as 20- to 40-microsecond puls- before and after photos of 543 growth rather than killing the es with a 1.5-microsecond delay. Treatments were at women who were treated for facial follicles. To prevent this, derma- 1-month intervals. For pain control, treated areas hair at a laser center in Spain from tologists in Spain began to use were pretreated with a eutectic mixture of lidocaine 78% EWS December 1998 to December 2003. ice packs, high fluence, and a Reduced N and prilocaine (EMLA), and also were treated with The women were aged 16-52 years; double-pass technique. hair growth contact cooling. 68% had type III skin, and the re- Since this method started in EDICAL “One drawback to this treatment is that it is painful maining women had either type II or late 2003, there have been no M to treat in the affected areas,” Dr. Troilius said. n = 543 women type IV skin. additional cases of paradoxical LOBAL Treatment of HS may be further refined by com- About 80% were treated with an hypertrichosis in any patients Note: Results are after 3-23 treatments. G bining hair removal with photodynamic therapy or alexandrite laser, whereas the others treated with this approach, Dr. Source: Dr. Willey anti-inflammatory therapy with newly available bi- LSEVIER ■ were treated with either an Nd:YAG Willey said. E ologic drugs. Low-Energy Laser for Pseudofolliculitis Barbae Reduces Pain G RAPEVINE, TEX. — Reduced laser energy can be ef- treatments are usually needed, at 4- to 6-week intervals. study, so they were excluded from the final analysis. fective and more acceptable to patients who are being This treatment is designed to permanently destroy hair Among the 11 evaluable patients, none developed pig- treated for pseudofolliculitis barbae, based on results follicles. mentation changes, crusting, blistering, or scarring. from a study with 11 evaluable patients. Dr. Schulze and his associates examined the efficacy The global efficacy assessment showed an average “Lower fluences offer hair modulation without per- and safety of treatment with a 1064-nm Nd:YAG StarLux 83% improvement for the composite of papule number, manent hair reduction,” Dr. Rafael A. Schulze said at the laser that delivered 12 J/cm2 with a 10-mm spot size and dyspigmentation, and cobblestone appearance, a statisti- annual meeting of the American Society for Laser Med- 20-millisecond pulses, producing a total power dose of cally significant difference, compared with baseline. icine and Surgery. 390 watts. Each of the individual assessments was also signifi- The hair follicles become smaller and weaker, and less The Lux handpiece contained a water-cooled sapphire cantly improved at follow-up, compared with baselines. prone to cause pseudofolliculitis barbae. Lower laser flu- window; no topical anesthesia was used. (See box.) ■ ences also mean less conductive heating and therefore less The treatment was designed not to destroy hair pain. Treatment with lower energy, at less than half the follicles but to cause a slight insult in them and make power usually used for hair removal, also means that the the hairs weaker and smaller, said Dr. Schulze, who Average Reductions From Baseline laser device can be smaller and potentially more portable, had no financial conflicts to disclose for this study. said Dr. Schulze, a dermatologist at Brooke Army Med- The study enrolled 21 men and 1 woman with With Low-Fluence Laser Treatment ical Center, Fort Sam Houston, Tex. pseudofolliculitis barbae and skin type IV-VI who Extent of Overall extent of Papule cobblestone Extent of pseudofolliculitis Pseudofolliculitis barbae, caused by the curling and were scheduled to receive weekly low-fluence laser count appearance dyspigmentation barbae growth of hair follicles into adjacent skin, occurs pri- treatments for 5 weeks, followed by 4 weeks of fol- marily in African Americans and causes inflammatory low-up. Their age range was 21-42 years, with an papules and pustules. It can also cause skin discol- average of 24. The participants were told to con- oration, hypertrophic or keloidal scarring, and sec- tinue whatever grooming methods they had used ondary infections. Standard treatments include topical before laser treatment, including clipping their fa- steroids, chemical depilatories, electrolysis, and laser hair cial hair and using a chemical depilatory. 59% EWS reduction. Photographs of the necks of each patient were N Standard laser hair reduction is done with a high-flu- assessed before and after treatment by a panel of 76% 2 ence device, usually at a dose of 22-40 J/cm , which de- 10 dermatologists, who scored the outcomes 83% EDICAL livers a total power of 940 watts at an energy level of based on papule counts, dyspigmentation, cob- 91% M 2 24 J/cm . This approach is painful in patients with blestone appearance, and global assessment. Thir- Note: Data based on a study of 11 patients who each received five LOBAL G darker skin and can cause pigmentation changes, scar- teen of the 22 patients completed the study. Two treatments for pseudofolliculitis barbae. ring, or blistering. The laser device needed to deliver this of the 13 completers failed to follow the protocol Source: Dr. Schulze LSEVIER energy is large and expensive, and at least two or three and changed their grooming method during the E.
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