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Dermatologic Surgery

SK I N & A L L E RG Y N E W S • June 2007

For Hidradenitis
Hypertricosis Not Uncommon
After Laser Removal of Facial Hair Suppurativa, Hair
MITCHEL L. ZOLER

Philadelphia Bureau

G R A P E V I N E , T E X . — Facial-hairremoval with laser energy can backfire and trigger hypertrichosis if theregimen is not optimized, Dr. Andrea Willey said at the annual meeting of the American Society for Laser
Medicine and Surgery.
In a review of more than 500
women who underwent photoepilation, it was found that paradoxicalhair stimulation occurred in about
10%, much more common than previously reported.
A reliable way to prevent this outcome is to cool the surrounding skinwith ice packs during laser treatment, along with using the maximum tolerated laser fluence and employing a double-pass technique, said
Dr. Willey, who is a dermatologist at
Oregon Health and Science University, Portland.
She and her associates reviewed
before and after photos of 543
women who were treated for facial
hair at a laser center in Spain fromDecember 1998 to December 2003.
The women were aged 16-52 years;
68% had type III skin, and the remaining women had either type II ortype IV skin.
About 80% were treated with analexandrite laser, whereas the others
were treated with either an Nd:YAG

Several dermatologists who heard
laser or intense pulsed light. They rethe report at the meeting said thatceived 3-23 treatments.
At follow-up, an average of 10% of their own anecdotal experience conthe women had increased facial hair, firmed Dr. Willey’s report.
“You can predict which women will
8% had no change, 78% had reduced
hair growth, and 3% had complete have this. They all have fine, almost
hair removal. The remaining 1% had downy hair on dark skin that is typeincomplete information and weren’t III or higher,” said Dr. Jeffrey S. Dover,a dermatologist in private practice inincluded in the analysis.
Women with hypertrichosis after Chestnut Hill, Mass.
“I don’t treat thin, wispy hairs ontreatment had the extra hair predominantly in their beard area. All of the neck because the likelihood of hythe affected women had prominent pertrichosis is so high,” added Dr. E.
vellus hair before treatment, noted Victor Ross, director of the laser andcosmetic dermatology unit at Scripps
Dr. Willey.
No apparent link between skin Clinic in San Diego.
■
type and hair growth was found.
Of the 57 women with hair
Results of Laser
growth, 16 had polycystic ovary
Facial-Hair Removal
syndrome or irregular menses.
The cause of paradoxical hy1%
Incomplete
pertrichosis in this setting is not3%
10% information Complete
clear, and several mechanisms
hair removal
Increasedprobably play a role, she said.
facial hairOne possibility is that sub8%
therapeutic laser energy injures
No change
hair follicles, thus stimulating
growth rather than killing thefollicles. To prevent this, dermatologists in Spain began to use
78%
ice packs, high fluence, and a
Reduceddouble-pass technique.
hair growth
Since this method started inlate 2003, there have been non = 543 women
additional cases of paradoxical
hypertrichosis in any patients
Note: Results are after 3-23 treatments.
treated with this approach, Dr.
Source: Dr. Willey
Willey said.

Removal Aids Tx

E LSEVIER G LOBAL M EDICAL N EWSARTICLES BY

G R A P E V I N E , T E X — Hair removal by intense
pulsed light is a useful adjunctive treatment for refractory hidradenitis suppurativa, based on experience with 10 patients at one center.
Five of the treated patients had clear improvementin their clinical status after 3-4 hair-removal treatments, with reduced or resolved lesions in the treated area. The remaining five patients had improvement
after four to eight treatments, Dr. Agneta Troilius saidat the annual meeting of the American Society ofLasers in Medicine and Surgery. The treatment also
resulted in less scarring than usually occurs whenhidradenitis suppurativa (HS) lesions resolve.
“Hair removal is one element of treatment” for adisease that affects as many as 4% of women, said Dr.
Troilius, head of the laser and vascular anomaly section of the department of dermatology at Lund University in Malmö, Sweden.
The series included women aged 21-45 years withskin type II or III who had active HS for several years
and had lesions that had affected their social lives.
Treatment was with an intense pulsed light (IPL) device, the Ellipse model made by Danish Dermatologic
Development, using the hair applicator to deliver645- to 950-nm light. Treatment was with a fluence of
17-19 J/cm2, delivered as 20- to 40-microsecond pulses with a 1.5-microsecond delay. Treatments were at
1-month intervals. For pain control, treated areas
were pretreated with a eutectic mixture of lidocaine
and prilocaine (EMLA), and also were treated withcontact cooling.
“One drawback to this treatment is that it is painful
to treat in the affected areas,” Dr. Troilius said.
Treatment of HS may be further refined by combining hair removal with photodynamic therapy or
anti-inflammatory therapy with newly available biologic drugs.
■G R A P E V I N E , T E X . — Reduced laser energy can be effective and more acceptable to patients who are being
treated for pseudofolliculitis barbae, based on resultsfrom a study with 11 evaluable patients.
“Lower fluences offer hair modulation without permanent hair reduction,” Dr. Rafael A. Schulze said at theannual meeting of the American Society for Laser Medicine and Surgery.
The hair follicles become smaller and weaker, and lessprone to cause pseudofolliculitis barbae. Lower laser fluences also mean less conductive heating and therefore lesspain. Treatment with lower energy, at less than half thepower usually used for hair removal, also means that thelaser device can be smaller and potentially more portable,
said Dr. Schulze, a dermatologist at Brooke Army Medical Center, Fort Sam Houston, Tex.
Pseudofolliculitis barbae, caused by the curling andgrowth of hair follicles into adjacent skin, occurs primarily in African Americans and causes inflammatory
papules and pustules. It can also cause skin discoloration, hypertrophic or keloidal scarring, and secondary infections. Standard treatments include topicalsteroids, chemical depilatories, electrolysis, and laser hair
reduction.
Standard laser hair reduction is done with a high-fluence device, usually at a dose of 22-40 J/cm2, which delivers a total power of 940 watts at an energy level of
24 J/cm2. This approach is painful in patients withdarker skin and can cause pigmentation changes, scarring, or blistering. The laser device needed to deliver thisenergy is large and expensive, and at least two or threetreatments are usually needed, at 4- to 6-week intervals. study, so they were excluded from the final analysis.
Among the 11 evaluable patients, none developed pigThis treatment is designed to permanently destroy hairmentation changes, crusting, blistering, or scarring.
follicles.
The global efficacy assessment showed an average
Dr. Schulze and his associates examined the efficacy
and safety of treatment with a 1064-nm Nd:YAG StarLux 83% improvement for the composite of papule number,laser that delivered 12 J/cm2 with a 10-mm spot size and dyspigmentation, and cobblestone appearance, a statisti20-millisecond pulses, producing a total power dose of cally significant difference, compared with baseline.
Each of the individual assessments was also signifi390 watts.
The Lux handpiece contained a water-cooled sapphire cantly improved at follow-up, compared with baselines.
(See box.)
window; no topical anesthesia was used.
■
The treatment was designed not to destroy hairfollicles but to cause a slight insult in them and makethe hairs weaker and smaller, said Dr. Schulze, who
Average Reductions From Baseline
had no financial conflicts to disclose for this study.
With Low-Fluence Laser Treatment
The study enrolled 21 men and 1 woman withpseudofolliculitis barbae and skin type IV-VI who
Extent ofOverall extent ofPapulecobblestone
Extent ofpseudofolliculitis
were scheduled to receive weekly low-fluence laser
countappearance
dyspigmentation
barbaetreatments for 5 weeks, followed by 4 weeks of follow-up. Their age range was 21-42 years, with anaverage of 24. The participants were told to continue whatever grooming methods they had used
before laser treatment, including clipping their facial hair and using a chemical depilatory.
59%
Photographs of the necks of each patient wereassessed before and after treatment by a panel of76%
83%
10 dermatologists, who scored the outcomes91%
based on papule counts, dyspigmentation, cobblestone appearance, and global assessment. ThirNote: Data based on a study of 11 patients who each received fiveteen of the 22 patients completed the study. Twotreatments for pseudofolliculitis barbae.
of the 13 completers failed to follow the protocol
Source: Dr. Schulze
and changed their grooming method during theE LSEVIER G LOBAL M EDICAL N EWS

Low-Energy Laser for Pseudofolliculitis Barbae Reduces Pain