Hair removal with the 3-msec alexandrite laser in patients with skin types IV-VI: efficacy, safety, and the role of topical corticosteroids in preventing side effects.
BACKGROUND
Laser hair removal targets melanin in the hair shaft. The abundance of melanin in the epidermis of patients with dark skin color has always been regarded as hazardous due to the increased incidence of side effects in this patient population.


OBJECTIVE
To establish the efficacy and safety of using the 3-msec alexandrite laser in patients with skin types IV to VI, and evaluate the role of topical corticosteroids in preventing side effects.


METHODS
Thirty-seven patients with skin types IV to VI and brown or black hair were recruited and divided into 2 groups. Twenty-six patients were treated with the 18-mm spot size and 11 patients were treated with the 15-mm spot size. Hair shafts in the treatment and control areas were counted and clipped for measurement of the thickness at the base. The laser was used with fluences between 8 and 32 J/cm2. Two 16-cm2 areas were treated; one area was pretreated with a class I topical corticosteroid (TCS) cream (betamethasone dipropionate) 10 minutes prelaser and twice a day for 5 days postlaser. The dynamic cooling device (DCD) spray duration was set at 90 msec, and the delay was set at 20 msec. Pain was graded on a scale from I to 10. Patients were followed up on day 1 and day 7 and at 1, 3, and 6 months. Histological samples from the 2 treatment areas and control were obtained from 5 patients. At follow-up visits, side effects were graded on a scale from 1 to 3. Hair reduction was evaluated by performing hair counts. The thickness of hair was measured microscopically at the base. Average hair count reduction and hair thickness were recorded at the 3- and 6-month visits.


RESULTS
Thirty-one patients completed the study. The average hair count reduction at 6 months was 35.4%. The average hair thickness reduction was 31.2%. At one week hyperpigmentation was seen in 48.4% of the laser only treated area and in 45.2% of laser/TCS treated area. The effect of TCS was minimal and more prominent at 1 and 3 months. The incidence of hyperpigmentation was higher in the 15-mm group than the 18-mm group as a result of using higher fluence. Hypopigmentation was generally preceded by crust formation and lasted up to 3 months. Reducing spot size resulted in decreased peripheral crust formation. TCS appears to have a role in reducing the erythema and crusting. Histopathology of both groups at day one showed necrosis of the follicular infundibulum and the inner layer of the perifollicular epithelium. No vascular damage was seen.


CONCLUSIONS
The 3-msec alexandrite laser utilized in this study provides a safe and effective treatment achieving long-term reduction of unwanted, pigmented hair in skin types IV and V, but is less safe in skin type VI. Using a TCS helps in minimizing post-treatment erythema and edema; it also decreases the duration of hyperpigmentation.
Aldraibi
Mohammed S
MS
King Abdulaziz University, Jeddah, Saudi Arabia.
Touma
Dany J
DJ
Khachemoune
Amor
A
D000279:Administration, Cutaneous; D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D001608:Beryllium / Q000737:chemistry*; D004487:Edema / Q000209:etiology; D004817:Epidermis / Q000187:drug effects / Q000528:radiation effects; D004890:Erythema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D018859:Hair Follicle / Q000000981:diagnostic imaging / Q000187:drug effects; D006204:Hair Removal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D017496:Hypopigmentation / Q000209:etiology; D028022:Low-Level Light Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D012880:Skin Pigmentation / Q000187:drug effects / Q000502:physiology* / Q000528:radiation effects; D012881:Skin Temperature / Q000187:drug effects / Q000528:radiation effects; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
D000305:Adrenal Cortex Hormones; C112654:alexandrite; D001608:Beryllium