- Laser Hair Removal
- Introduction
- Unconventional LHR Indications
- Pilonidal sinus
- Hidradenitis is suppurativa
- Cellulitis: A detailed analysis
- Folliculitis decalvans
- Pseudofolliculitis barbae
- Acne keloidalis nuchae
- Trichostasis spinulosa
- Keratosis pilaris
- Hyperhidrosis axillary
- Becker’s Nevus
- Hair-bearing skin flaps or grafts
- Reconstruction of intraoral structures
- Urethral surgery
- Hair growth by peristomal methods
- Conclusion
- References
Since its inception, laser hair removal has been used mainly for aesthetic purposes. It has become a valuable therapeutic modality for many dermatological and surgical conditions.
All laser hair removal systems can be used, depending on the skin type. There have been very few complications and good results.
Here are some examples of laser hair removal that may not be obvious.
Introduction
In dermatology, lasers are indispensable tools. Laser hair removal (LHR) is still one of the most popular laser treatments in dermatology. Because of its non-invasive nature, long-term results, and minimal discomfort, LHR has been very popular.
Laser hair removal works on the principle of selective photo-thermolysis using melanin as the target chromophore. This allows for permanent hair reduction by selective destruction of the hair follicle.
LHR can also be done with dia, ruby, Alexandrite and neodymium-yttrium aluminiu garnet (NdYAG) lasers. IPL sources operate at different wavelengths that are suitable for different skin types.
LHR’s primary purpose is to remove unwanted hair from females suffering from hirsutism or hypertrichosis. Numerous long-term studies have shown that different laser systems can reduce hair growth. Repetitive treatments also show an improvement in efficacy.
Many dermatological conditions associated with hair follicular dysfunction as the primary dysfunction have been treated using Laser hair removal over the years.
Chronic inflammatory conditions such as pilonidal syndrome (PSD), hidradenitis sopurativa (HS), dissecting folliculitis (PFB), and other disorders have been treated with LHR.
These conditions are thought to be caused by inflammation, rupture, or occlusion of the follicular units.
These disorders can often be treated with medical treatments that are both partial and permanent. These disorders can be treated with laser-induced damage and epilation.
Permanent hair removal is required for conditions that are not related to follicular inflammation. LHR is the best option to prevent future recurrences in these cases.
LHR is an effective and safe treatment option for these conditions. It has been used safely even with children and has resulted in functional and symptomatic improvement. These indications have low incidence and minor side effects.
Unconventional LHR Indications
Pilonidal sinus
The painful and debilitating condition of PSD of the natal Cleft can be very distressing. The standard treatment is to have the sinus tract completely surgically extricated.
However, it’s not uncommon for the condition to recur, with rates ranging from 11-14%. Laser epilation is a good adjunct to surgery because of the association with excess hair in the sacrococcygeal area.
Ideally, four sessions of LHR are recommended to achieve the best results. A low number of sessions can lead to high relapse rates. One study with a mean of 2.7 sessions found that the recurrence rate was 13.3% for a period of 4.4 years.
Laser hair removal in PSD is generally well tolerated without major complications. You can reduce the pain by using local/topical anesthetic agents. PSD that had recurring disease recurrences despite numerous surgical interventions and antibiotic treatment was successfully treated by LHR.
This resulted in persistent sinuses, reduced hair thickness and density, and improved quality of life. After 6-8 sessions, there were no signs of disease exacerbations.
Long-term follow-up studies showed no recurrences in 86.6% of patients who received LHR over a 5-year period. In this indication, different devices were used, including Nd: YAG, Alexandrite, and diode lasers. All of these devices showed positive results.
One study using diode laser had a 5.5-year follow-up. In this study, there were no recurrences.
Hidradenitis is suppurativa
HS is a chronic, disabling disorder that can cause exacerbations, progression, and recurrence despite extensive medical and surgical treatment. Laser hair removal has been successfully used to treat HS, despite mounting evidence of primary follicular pathogenesis.
This condition has shown significant therapeutic benefits after Laser hair removal with Nd: YAG laser, diode laser, and IPL devices. Because of its deeper penetration into the tissue, Nd: YAG long-pulse laser is preferred for this indication.
The 20 patients with HS had histopathological results analyzed using biopsy specimens taken at specific intervals before and after treatment. This correlation showed that the patient’s clinical improvement after treatment with a 1064-nm Nd.YAG laser was correlated with the time period between treatments.
Two treatments were given to each affected area. Untreated areas served as controls. The laser parameters were adjusted according to skin type. They ranged from 25-50 J/cm2 with an area size of 10mm and a pulse duration of 20 to 35 seconds.
For all inflammatory lesions, double pulse stacking was used for the first treatment. Triple pulse stacking was used for the second treatment. Within a month, the inflammation had subsided, and there were no broken hair shafts.
The investigators discovered scarring, fibrosis, and minimal inflammation at 2 months. The investigators noted a 32% improvement in the treated areas 2 months after the second treatment. A significant improvement of 72.7 percent was also noted in the four-month treatment period and two months afterward, clinically as well as histologically.
The treatment must be very aggressive to prove efficacy. This is evident by the use of stacked pulses and histologic evidence that there was scarring and fibris.
Laser treatment was more effective for inflammatory lesions than those in the inframammary area. However, they healed quicker.
After 3 years of follow-up, no recurrences were observed when LHR was combined with deroofing using carbon dioxide laser.
Cellulitis: A detailed analysis
Dissecting Cellulitis is a chronic, inflammatory scalp condition that causes pustular nodules and sinus tract formation. It can also lead to cicatricial hair loss. The current treatments have limited effectiveness.
Although destructive therapy with X-rays can be effective, it is no longer recommended. Laser hair removal is effective in reducing the severity of dissecting cellulitis. There have not been any adverse side effects.
Patients experience decreased pus production, reduced dependence on systemic therapies, and a controlled or ended disease process without dyspigmentation.
One severe case of dissecting cellulitis on the scalp was treated with diode laser monotherapy. It did not recur after a 6-month follow-up.
Some patients also reported terminal hair regrowth at the treatment sites one year after starting laser treatment.
Folliculitis decalvans
Folliculitis decalvans (FD), a group of inflammatory scalp conditions, is characterized by follicular papules, pustules, tufted folliculitis, and cicatricial alopecia.
The majority of current treatments are antibiotic-based and often fail to work. Laser hair removal has been used to treat recalcitrant FD in a limited number of cases.
All these studies used long pulse NdYAG laser over multiple sessions. Treatment was well tolerated.
Pseudofolliculitis barbae
PFB is a common condition that affects many people with curly hair. The current treatment options are not optimal. Because shaving results in short and sharp hair stumps that reenter or retract into the skin, this is a risk factor.
LHR may be beneficial in reducing disease severity. This is done by decreasing the number and/or depth of hair shafts.
Long-term PFB with Laser hair removal has shown a greater than 50% improvement. Laser hair removal with NdYAG laser is safe and effective in reducing hair growth and papule formation in PFB.
The laser-irradiated areas showed significantly lower papule counts than the control. Another study showed a 56% reduction in PFB lesion size after three passes with the Nd: YAG Laser.
A total of five weekly low-fluence laser treatments at 1064nm, each with a frequency of 12 J/cm2, resulted in a significant temporary decrease in PFB lesions that were not responding to conventional therapy.
After Alexandrite LHR treatment for below-the-knee amputation stump PFB, there was a marked decrease in hair density.
Acne keloidalis nuchae
Acne keloidalis nuchae is a chronic inflammatory disorder that affects hair follicles at the nape of your neck. This causes disfiguring keloidal scars. There are limited treatment options available.
LHR, like other chronic inflammatory follicular disorders, is being investigated as a first-line therapy modality. It is safe and effective and has a low recurrence.
After 4 sessions of diode laser treatment, 90-97% of lesions were cleared in a study. Patients treated with Nd: YAG and Alexandrite lasers showed significant improvement in their early cases compared to those in late cases.
However, Er: YAG laser was more effective in both early and late cases than Nd: YAG.
Trichostasis spinulosa
Trichostasis Spinulosamultiple hairs
Only temporary relief is available from the various treatment options. Laser hair removal therapy is a definitive treatment that removes the hair responsible for the plugged appearance.
It is effective, with minimal discomfort and side effects. There is no recurrence even after two years.
Keratosis pilaris
Keratosis Pilarisfollicular prominence
To reduce the erythema, but not the textural irregularity, shorter-wavelength vascular lasers were used. After 3 treatments with the 810-nm laser, KP patients saw significant improvement in their skin texture and bumpiness. These improvements were spaced out over 4-5 weeks.
Hyperhidrosis axillary
Axillary Hyperhidrosis, a disorder of the eccrine sweat cells, is distressing. There are currently no effective treatments and many side effects. Monthly sessions of LHR with Nd: YAG laser showed significant subjective and objective improvements in sweating.
In one of these trials, a right/left controlled comparison trial of Laser hair removal, significant subjective and objective improvements were noted in sweating following monthly sessions. Laser hair removal was found to have destroyed the eccrine cells.
The statistically significant differences between the two groups were not evident in a left-right controlled comparison trial using an 800-nm diode light source laser.
This contrasts with the previous studies. Both sides showed a decrease in sweat rate, which could be attributed to a placebo effect.
Becker’s Nevus
Becker’s Nevus can be a very troublesome condition. While there have been a few lasers used for this condition, most cases are still unsatisfactory. Laser hair removal has been shown to reduce hair density and delay hair growth in Becker’s Nausea.
Laser hair removal in Becker’s nevus poses a problem for hypertrichosis and the background of hyperpigmentation. The risk of blistering is due to pigment absorption from the pigmented epidermis. At 12 months, significant hair clearing was observed.
Low fluence, high repetition rate diode-lasers for a gradual heating of hair shaft and perifollicular tissues were used.
A 20-year old male with Becker’s Nausea was successfully treated by 6 sessions of long-pulsed 1064-nm NdYAG laser at 6-week intervals, followed by 5 long-pulsed 755-nm Alexite laser sessions at 3-month intervals.
LHR can also be used in needy conditions. Alexandrite Laser has been used in two cases in need of localized hypertrichosis in children between 10 and 12 years old.
Hair-bearing skin flaps or grafts
After surgery, hair-bearing skin flaps or grafts can result in hair growth at an abnormal site. LHR has been successfully used to reconstruct breast cancer, nose reconstruction following basal cell carcinoma, post burns, and other injuries.
Reconstruction of intraoral structures
Sometimes, intraoral reconstructions in neck and head cancers can include transfer flaps made of hair-bearing tissue. Patients with hairy intraoral flaps are more likely to experience irritation, food trapping, and saliva pooling.
Laser hair removal has been used in epilation. Laser treatment was effective in reducing intraoral hair, regardless of the flap type. This is except for one white male. Laser hair removal in these cases is difficult due to poor visibility and the bulky laser handpiece in the narrow oropharyngeal space.
A patient who had a reconstructed hypopharynx after postlaryngopharyngectomy with Alexandrite laser showed marked improvement in symptoms.
The handpiece was 7 mm long and had a 90-degree side-firing fiber optic attachment. It passed through the lumen with a suspension laryngoscope.
Surgery to confirm the gender of genital sex is available
Gender affirming surgery (GAS), which reconstructs the genitals to match the patient’s sex, is genital gender-affirming surgery. This procedure uses hair-bearing flaps to reduce postoperative intravaginal hair growth.
Although electrolysis has been used for hair removal before GAS, Laser hair removal has been proven to be superior.
It is best to wait three months after your last hair removal procedure before you proceed with surgery. This will ensure that there is no hair regrowth. Preoperative hair removal is not required for vaginoplasty.
To create a neovaginal space, vaginoplasty must be performed with the penile shaft skin hairless (penile inversion viginoplasty).
Sometimes it is safer to remove the entire scrotum for permanent hair removal. Transgender men undergoing phalloplasty (construction of a neourethra) will need permanent hair removal before the procedure.
In radial-artery phalloplasty, the skin for urethral lengthening involves removing skin from the medial side of the entire ventral forearm or the middle 2/3 of the anterolateral forearm (ALT) in ALT-flap phalloplasty. After vaginoplasty, Laser hair removal was not performed on the scrotal skin.
Urethral surgery
Hypospadias and stricture repairs are performed using cutaneous flaps. These flaps are usually hair-bearing. This surgery can lead to the formation of urethral calculi. LHR has been used to remove urethral hair in several cases.
There have been no side effects reported, and the results were satisfactory for up to one year. Transurethral Laser hair removal was performed using a diode laser with a power of 15W through a side-firing fiber laser.
Hair growth by peristomal methods
Many people who have an ileostomy experience peristomal hair growth. It can also make it difficult to adhere the stomal device to the skin. Folliculitis can be caused by frequent shaving, especially if it is done frequently. Laser hair removal has led to effective epilation.
This results in better stoma appliance adhesion and a reduced risk of infection and trauma.
Redesign the frontal hairline with hair restoration surgery for women
Women often experience an unnatural appearance after hair transplants for their hairline correction. This is due to thicker donor hairs from the occipital area. As women have more fine hair at the frontal portion of their hairline, this can lead to hair transplantation.
Many surgical options can be used to improve the hairline, each with its own limitations and complications. Park et al. found that LHR can be used to improve the hairline after hair transplantation.
It showed a subjective improvement of 87.5% and a significant decrease in hair diameter. Long-pulsed NdYAG laser irradiation at a short pulse width (35-36J/cm2 and 6-ms) was used to prevent any damage to the transplanted hair.
LHR can be used as an alternative for creating fine hair. It is useful for women who have a revised hairline or other areas that require fine hair.
Conclusion
Laser hair removalpopularity
Laser hair removal is well-tolerated and safe even in children. It has helped to reduce the morbidity and quality of life associated with many chronic and recurrent conditions.
References
1. Olse EA. Methods of hair removal. J Am Acad Dermatol 1999;40:143-55.
2. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983;220:524-7.
3. Gan SD, Graber EM. Laser hair removal: a review. Dermatol Surg 2013;39:823-38.
4. Hussain M, Polnikorn N, Goldberg DJ. Laser-assisted hair removal in Asian skin: efficacy, complications, and the effect of single versus multiple treatments. Dermatol Surg 2003;29:249-54.
5. Chicarilli ZN. Follicular occlusion triad: hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. Ann Plast Surg 1987;18:230-7.
6. Rajpar SF, Hague JS, Abdullah A, Lanigan SW. Hair removal with the long-pulse alexandrite and long-pulse nd:YAG lasers is safe and well tolerated in children. Clin Exp Dermatol 2009;34:684-7.
7. Lanigan SW. Incidence of side effects after laser hair removal. J Am Acad Dermatol 2003;49:882-6.
8. Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 2005;190:388-92.
9. Schulze SM, Patel N, Hertzog D, Fares LG 2nd. Treatment of pilonidal disease with laser epilation. Am Surg 2006;72:534-7.
10. Conroy FJ, Kandamany N, Mahaffey PJ. Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 2008;61:1069-72.
11. Benedetto AV, Lewis AT. Pilonidal sinus disease treated by depilation using an 800nm diode laser and review of the literature. Dermatol Surg 2005;31:587-91.
12. Lavelle M, Jafri Z, Town G. Recurrent pilonidal sinus treated with epilation using a ruby laser. J Cosmet Laser Ther 2002;4:45-7.
13. Downs AM, Palmer J. Laser hair removal for recurrent pilonidal sinus disease. J Cosmet Laser Ther 2002;4:91.
14. Odili J, Gault D. Laser depilation of the natal cleft-an aid to healing the pilonidal sinus. Ann R Coll Surg Engl 2002;84:29-32.
15. Landa N, Aller O, Landa-Gundin N, Torrontegui J, Azpiazu JL. Successful treatment of recurrent pilonidal sinus with laser epilation. Dermatol Surg 2005;31:726-8.
16. Lukish JR, Kindelan T, Marmon LM, Pennington M, Norwood C. Laser epilation is a safe and effective therapy for teenagers with pilonidal disease. J Pediatr Surg 2009;44:282-5.
17. Badawy EA, Kanawati MN. Effect of hair removal by nd:YAG laser on the recurrence of pilonidal sinus. J Eur Acad Dermatol Venereol 2009;23:883-6.
18. Abbas O, Sidani M, Rubeiz N, Ghosn S, Kibbi AG. Letter: 755-nm alexandrite laser epilation as an adjuvant and primary treatment for pilonidal sinus disease. Dermatol Surg 2010;36:430-2.
19. Yeo MS, Shim TW, Cheong WK, Leong AP, Lee SJ. Simultaneous laser depilation and perforator-based fasciocutaneous limberg flap for pilonidal sinus reconstruction. J Plast Reconstr Aesthet Surg 2010;63:e798-800.
20. Lindholt-Jensen CS, Lindholt JS, Beyer M, Lindholt JS. Nd-YAG laser treatment of primary and recurrent pilonidal sinus. Lasers Med Sci 2012;27:505-8.
21. Ghnnam WM, Hafez DM. Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthet Surg 2011;4:192-5.
22. Oram Y, Kahraman F, Karincao?lu Y, Koyuncu E. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg 2010;36:88-91.
23. Koch D, Pratsou P, Szczecinska W, Lanigan S, Abdullah A. The diverse application of laser hair removal therapy: a tertiary laser unit’s experience with less common indications and a literature overview. Lasers Med Sci 2015;30:453-67.
24. Tierney E, Mahmoud BH, Srivastava D, Ozog D, Kouba DJ. Treatment of surgical scars with nonablative fractional laser versus pulsed dye laser: a randomized controlled trial. Dermatol Surg 2009;35:1172-80.
25. Highton L, Chan WY, Khwaja N, Laitung JK. Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study. Plast Reconstr Surg 2011;128:459-65.
26. Downs A. Smoothbeam laser treatment may help improve hidradenitis suppurativa but not hailey-hailey disease. J Cosmet Laser Ther 2004;6:163-4.
27. Xu LY, Wright DR, Mahmoud BH, Ozog DM, Mehregan DA, Hamzavi IH. Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nm nd:YAG laser treatment. Arch Dermatol 2011;147:21-8.
28. Mahmoud BH, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol 2010;62:637-45.
29. Jain V, Jain A. Use of lasers for the management of refractory cases of hidradenitis suppurativa and pilonidal sinus. J Cutan Aesthet Surg 2012;5:190-2.
