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HIRSUTISM AND HYPERTRICHOSIS: the role of photo-induced â€œpermanent hair reductionâ€. Dr. Tzermias Christopher GREECE.
Dr. Tzermias Christopher
HIRSUTISMExcessive growth of coarse terminal hair in a pattern more characteristic of adult men.9-15% college aged females have severe hirsutismHYPERTRICHOSISPresence of excess hair in any body site.
Congenital adrenal hyperplasia
Androgen-secreting ovarian neoplasms
OvarianSevere insulin resistanceAndrogen secreting ovarian neoplasmsCombined adrenal and ovarianPolycystic ovary syndromeIdiopathic hirsutismExogenous androgensAnabolic steroidPostmenopausal androgen therapy
Cyclosporin, streptomycin, cortisone, penicillamine
Porphyria cutanea tarda,
epidermolysis bullosa, Hurler’s syndrome
Long standing inflammatory changes
NEW:EFLORNOTHINE.Inhibitor of ornithine decarboxylase, necessary for the biosynthesis of polyamines required for cell division and differentiation.A supplementary method.Applied twice daily 8 hours apart.Visible results after 8 weeks.
Laser hair removal is based on theory of Selective Photothermolysis:Selective thermal damage of a pigmented target will occur when sufficient fluence at a wavelength mostly absorbed by the target is delivered during a time equal to or less than thermal relaxation time of the target.For hair removalFOLLICULAR MELANINis the chromophore
The bulb:2-7cm below epidermis
The bulge:1.5cm below epidermis
Heating the bulge
without damaging the bulb
to hair follicles
Anrian RM:J Cutan Laser Ther 2000;49-51
Early anagen is more suitable because:
HOWEVER a study has shown that damage is not confined to anagen hair
HOWEVER, excellent results have been obtained with shortened treatment intervals.
Two factors need to be considered
Most appropriate wavelengths:600-1200m
stem cells_surrounding the hair shafts
HOWEVER the long-pulsed Alexandrite laser has given equivalent results
at 6 months follow up at pulse durations 5, 10 and 20msec.
Nanni et Alster:Laser Surg Med 1999;24:332-337
target (bulge) has to be damaged
by heat diffusion from the highly pigmented/strongly absorbing one
(hair shaft and matrix cells).
distant target heating.
Altshuler et al: Laser Surg Med 2001;29:416-432
Greater photon density is present deeper
in the tissue for larger spots but the dermal/epidermal damage ratio is increased.
A larger spot size causes more pain than a smaller spot at identical fluencies.
Eremia et al: Derm Surg 2000;26:667-669
The use of larger spot sizes improves the growth delay of hairs measured 1 month after treatment.
Baumler et al: derm Surg 2002;28(2):118
= Skin cooling
(short bursts of cryogen delivered prior to laser pulse)
Postcooling is useful to minimize pain and edema.
= Hair similar in number but lighter and thinner
= Permanent vellus like hair
Bulb and bulge damage
Laser treatment usually produces complete but temporary hair loss for 1 to 3 months followed by partial but permanent hair loss.Temporary= delay in hair growthPermanent=stable for a period longer than the complete hair growth cycle.
Follicular responses to laser treatment
3. Other procedures
4. Previous treatments for hair removal
Six weeks before
( for darker skin types )
Day of treatment
Transient hyperpigmentation ( 10%)
Transient hypopigmentation ( 10%)
Permanent pigmentary changes in dark skinned individuals ( rare)
Due to induction in the dermis,
or activation of the bulge?
Better long term results if laser is combined with enzymes applied by iontophoresis
A variable but statistically significant increase in sebum excretion has been noted after laser hair removal. Although a reduction in sebaceous gland size has been observed, a decreased resistance to sebum outflow following miniaturization of the hair shaft might explain this phenomenon.Manuskiatti et al: J Am Adad Dermatol 1999;41:176-80
Lasers for hair removalLong pulse rubyLong pulse AlexandriteDiodeQ-Switched Nd:YAGLong pulsed Nd:YAGNon laser devicesIntense pulsed light sources
Greater absorption by melanin
Hair counts are reduced by 30% after a single treatment with the ruby laser and by 60% after 3 or 4 treatments.Dierickx C: Derm Clin 2002; 20(1):135-146Persistent hair loss was noted at 1 to 2 years follow up, greatest in sites treated at the highest fluence with Ruby Laser.Dierickx et al: Arch Dermatol 1998;134:837-844
40-56% reduction of hair growth on lip, legs and back was noted at 6 months after 1 treatment with the variable pulsed Alexandrite laser.McDaniel et al:Derm Syrg 1999;25:425-430Alexandrite laser vs DiodeEquivalent clinical and histologic responses are obtained.Handrick et Alster: Derm Syrg 2001;27(7):622Eremia et al: Derm Surg 2001;27(!!):925-92
Higher fluences and multiple treatments with the diode laser produce better long-term resultsCampos et al:J Am Acad Dermatol 2000;43:442-720 months after 2 treatments at variable anatomic sites with the diode laser 33-44% hair reduction was noted with minimal side effects.Lou et al: Derm Surg26:428-432Tripple pulsing does not increas hair reduction, while multiple treatments are associated with more effective hair reduction both short and lonh-term.Lou et al: Derm Surg;26:428-432
At 30 and 100msec pulse durations and flyences between 15 and 40 J/cm2 has been proved effective and safe for type V and VI African American patients. Longer pulse durations enabled the delivery of higher fluences with only transientpigmentary disturbances.Adrian et al: j Cutan Laser Ther 2000;2:183-190
A super long-pulsed (200-100msec) 810nm diode laser was used in suntanned patients. 34% hair reduction was noted after 1 or 2 treatments and this rate was affected by the variable fluencies and pulse durations.
Side effects were observed only with the highest fluences and pulse durations.
Super long pulse technology allows for
safer delivery of much higher fluences.
Rogachefsy et al: J Cutan Laser Ther2001;3:57-62
Q-switched Nd:YAG systems although capable of including delayed regrowth are ineffective regarding long-term hair removal.Nani et Alster: J Am Acad Dermatol 1999;41:165-171A larger pulsed Q-switched Nd:YAG laser (30msec) was found more effective than Q-switched (nanoseconds) Nd:YAG and with minimal side effects. However, results were not evaluated long-term .Goldberg et Samady: Derm Surg 2000; 26:109-113
At 1 year follow up after 3 treatments delivered on monthly basis with the long-pulsed Nd:YAG laser at fluences 40-50 J/cm270 to 90% hair reduction was noted in darkly pigmented individuals. The good results were confirmed histologically and minimal side effects were recorded.Alster at al: Arch Dermatol 2001;137:885-889
Greater than 50% hair reduction was documented 1 year after 5 treatments with the long-pulsed Nd:YAG laser, whereas 0% after 1 treatment.Blond hair, although less effectively, can also be removed.Lorenz et al: Lasers Surg Med 2002;30(2):127Areas characterized by thinner skin ( axillae ) are more responsive to laser treatment than those with thicker skin ( chin, legs ).?Skin thickness rather than hair growth cycle affects clinical outcome.Alster et al: Arch Dermatol 2001; 137:885-88
Different fluences with long-pulsed Nd-YAG laser (50,80 or 100 J/cm2) do not affect the outcome Hair reduction was 29%, 29% and 27% respectively at 3 months follow up.Coldberg et Silapunt: Derm Surg 2001;27(5):434-6On the contary, histologic evaluation of skin biopsies taken after treatment with the long-pulsed Nd:YAG laser revealed the degree of hair follicle damage is dependent on the fluence applied.Fournier et al: J Cutan Laser Ther 2000;2(3):125-130Comparing the efficacy and complications of long pulsed Nd:YAG and diode laser similar results were obtained. Chan et al: Derm Surg 2001;27(11):950-4
A light/heat assisted flashlamp hair removal system emitting light at 400-1200mm has been evaluated in 12 patients and average 27% hair reduction 4 months after the final treatment.
No statistical difference was noted
between 1 and 3 treatments.
Mechanism of action: Bulbe thermal heating raises the temperature of treated hair and surrounding tissue above boby temperature(55-65C) then the delivered light raises the temperature to 75-80C.
Goldberg et Silapunt et Silapunt: J Cutan Thr 2001;3:3-7
Dr. Tzermias Christopher
Treatment of Tanned Skin is unknown at this time.
Based on experience with other lasers BLISTERING and HYPOPIGMENTATION MAY RESULT.
Recommendations for preventing untoward effects and/or decrease discomfort
Reduction of Plume and Hair Odor in Treatment Room
Always Hold Laser Handpiece
Perpendicular To Site To Apply Laser Energy