Avoiding laser hair removal complications.(Lasers and beyond)

Dermatology Times

Dermatology Times; 6/15/2004; Nataloni, Rochelle
http://www.laser-body-hair-removal.info/
http://www.laser-body-hair-removal.info/news/news.html

Dallas — Increased hair growth is a potential complication of laser and light source hair removal, and can occur if an inadequate amount of fluence is used, according to Suzanne L. Kilmer, M.D., director of the Laser and Skin Surgery Center of Northern California.

This complication joins more well-known laser hair removal challenges: dark skin, tanned skin, and cooling methods.

“Laser and light source hair removal have come a long way in the recent past, but several potential complications remain,” says Dr. Kilmer. “The best way to decrease complications is to tailor an appropriate treatment for each individual, which includes using the right laser and the right fluence. You want it to be high enough to be effective so that it actually kills the hair, but not so high that it causes blistering,” she adds.

Increased hair growth

A more recently recognized complication of laser hair removal is increased hair growth.

“If you don’t treat with a high enough fluence, you can actually stimulate hair growth. This will be more common in Mediterranean and Middle Eastern people, or those who tan easily, and it is most likely to occur in the beard region, or some area where there is fine hair growth,” says Dr. Kilmer. “If you don’t sufficiently kill the hair, you just irritate it and trigger more hair growth. This is a well known phenomenon in animals in that they have increased hair growth in areas that have been injured, and we’re starting to see that this can happen in people, too.”

Skin types

The lighter the patient’s skin, the more options there are in laser choice, Dr. Kilmer points out.

In patients with darker skin, the best option is a laser that provides a longer wavelength.

“The longer wavelengths help the light get through the epidermis without causing any injury at the site of treatment,” she says.

Longer pulse widths, too, are most effective for darker skin types because the pulse widths help the melanin in the epidermis dump the heat more easily, whereas the hair follicles continue to accumulate heat, Dr. Kilmer reports at the annual meeting of the American Society for Laser Medicine and Surgery.

Right laser, right settings

In addition to choosing the right laser and the right settings, employing effective cooling–especially in darker skin types–is crucial.

“Pre-cool or concomitantly cool the epidermis so that the heat rise doesn’t have as much effect on the epidermis,” she suggests. “Essentially, for darker skin, you’re going to want a longer wavelength, a longer pulse width, and good cooling,” she explains.

Tanning is another issue to be aware of before designing a laser hair removal treatment for a given patient.

“If a darker skin tone is from a tan, you are more likely to have a problem because tanned skinned gets injured more easily than equally dark natural skin color,” says Dr. Kilmer.

In addition to directing patients to avoid sun exposure to the area that will be treated, Dr. Kilmer recommends comparing the treatment area to another area on the body that is not normally exposed, such as the buttocks.

“You can usually tell if somebody who is Caucasian is tanned, but with some of the darker skin types like Indian, Hispanic or Mediterranean, they may say they’re not tanned, but if you look at a non-sun exposed area of their body you can see whether it is darker or not. Don’t take the patient’s word for it,” she says. “Only by comparing the exposed skin to the non-exposed skin can you truly know how much of it is a built up browning or tan.”

Side effects

Among the potential side effects of laser and light source hair removal are contact dermatitis, prolonged or delayed follicular edema, hyperpigmentation and hypopigmentation.

Contact dermatitis can arise from numbing cream, antibiotic ointment, or anything that comes in contact with the skin.

Follicular edema is normal immediately after treatment, Dr. Kilmer points out, but in rare cases, it can be prolonged and last several days. Blistering can lead to hyperpigmentation or hypopigmentation.

“Hypopigmentation is more of a concern because it is possible to permanently lose some color,” says Dr. Kilmer. “Whereas in the instance of hyperpigmentation, this can be treated with topical bleaching cream.”

Another potential complication is scarring, which is also a result of blistering.

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