ASLMS: Tips for Effective Laser Hair Removal in Darker Skin

PHOENIX - When performing laser hair removal in patients with Fitzpatrick skin types IV-VI, keep in mind that darker skin contains more melanin in the epidermis, which acts as a competing chromophore, "so the risk for epidermal injury is higher," Dr. Andrew F. Alexis said.

Other tips to remember when treating this patient population include the melanocytes' tendency "to be labile in response to injury and inflammation, so there is an increased risk of dyschromia," Dr. Alexis said at the annual meeting of the American Society for Laser Medicine and Surgery. "This can manifest as hyperpigmentation or hypopigmentation following laser hair removal procedures."

He went on to note that fibroblasts in the dermis "are also more reactive to injury, so there is an increased risk of hypertrophic scars and keloids when performing surgical or some cosmetic procedures. In addition, having curved follicles [which are primarily seen in people of African descent] is associated with an increased prevalence of a number of follicular disorders."

His guidelines for performing laser hair removal safely on skin of color include longer wavelengths, lower fluences, longer pulse durations, and increased epidermal cooling.

"You want longer wavelengths because we're trying to maximize the ratio of follicular bulb temperature to epidermal temperature," explained Dr. Alexis, director of the Skin of Color Center at St. Luke's & Roosevelt Hospitals, New York, and assistant professor of dermatology at Columbia University.

"Using wavelengths in the near infrared range, we are at a lower point on the melanin absorption curve and therefore are compromising some efficacy, but this is the range that is considered safest for darker skin types," he noted.

A review found that the long-pulsed 1064-nm laser had the lowest incidence of adverse events in dark-skinned patients, followed by the long-pulsed 800-nm or 810-nm diode laser (J. Drugs Dermatol. 2007;6:40-6).

"For patients with type IV or V skin, the diode laser is appropriate, as long as you are using long pulse durations," he said, "but for the darker skin types, particularly type VI, the 1064-nm Nd:YAG laser is the best choice for safety reasons."

In one study, researchers used a 1064-nm laser with contact cooling to treat pseudofolliculitis barbae in 37 patients with skin types IV, V, and VI. They found that the highest fluences tolerated by the epidermis were 50 J/cm2 for skin type VI and 100 J/cm2 for skin types IV and V (J. Am. Acad. Dermatol. 2002;47:263-70).

In another study, researchers used a 1064-nm laser with contact cooling for hair removal in 36 patients with skin types I-VI (Dermatol. Surg. 2004;30:13-7). Patients underwent three consecutive treatments at 4- to 6-week intervals. For skin types V-VI, investigators used a 30-millisecond pulse duration and a fluence of 30-45 J/cm2 on the face and 35-50 J/cm2 on nonfacial sites. Six months post treatment, the mean facial hair reduction ranged from 41% to 46%, while the mean hair reduction on the body ranged from 48% to 53%.

Based on the results of these and other studies, and from his own clinical experience, Dr. Alexis recommends a pulse duration of 100 milliseconds or 400 milliseconds when using a 810-nm diode laser and a duration of 20-30 milliseconds when using a 1064-nm Nd:YAG laser with contact cooling.

One recent study used a 1064-nm Nd:YAG laser with lower than traditional fluences for treating 22 patients with skin types IV-VI who had pseudofolliculitis barbae (Dermatol. Surg. 2009;35:98-107). Patients underwent five weekly treatments on the neck with a fluence of 12 J/cm2 and a pulse duration of 20 milliseconds and a spot size of 10 mm. At 4 weeks follow-up, the papule count had been reduced by a mean of 91% and dyspigmentation by a mean of 60%.

In another recent development, researchers studying a novel diode laser with a fluence of 5-10 J/cm2 used at a repetition rate of 10 Hz found that it resulted in less pain, faster treatment, and fewer adverse events compared with one pass of a high-fluence diode laser at 25-40 J/cm2 in Fitzpatrick skin types I-V (J. Drugs Dermatol. 2009;8:s14-7).

Options for epidermal cooling include cold gel, contact cryogen or forced air, and post treatment with ice packs for 10-15 minutes. Devices for contact cooling feature either a sapphire tip or chilled copper plate. Regardless of which type of contact cooling chosen, Dr. Alexis suggested "using a slower treatment speed in order to ensure adequate cooling before delivering pulse."

Dr. Alexis said that he had no relevant financial conflicts.

PHOENIX - When performing laser hair removal in patients with Fitzpatrick skin types IV-VI, keep in mind that darker skin contains more melanin in the epidermis, which acts as a competing chromophore, "so the risk for epidermal injury is higher," Dr. Andrew F. Alexis said.

Other tips to remember when treating this patient population include the melanocytes' tendency "to be labile in response to injury and inflammation, so there is an increased risk of dyschromia," Dr. Alexis said at the annual meeting of the American Society for Laser Medicine and Surgery. "This can manifest as hyperpigmentation or hypopigmentation following laser hair removal procedures."

He went on to note that fibroblasts in the dermis "are also more reactive to injury, so there is an increased risk of hypertrophic scars and keloids when performing surgical or some cosmetic procedures. In addition, having curved follicles [which are primarily seen in people of African descent] is associated with an increased prevalence of a number of follicular disorders."

His guidelines for performing laser hair removal safely on skin of color include longer wavelengths, lower fluences, longer pulse durations, and increased epidermal cooling.

"You want longer wavelengths because we're trying to maximize the ratio of follicular bulb temperature to epidermal temperature," explained Dr. Alexis, director of the Skin of Color Center at St. Luke's & Roosevelt Hospitals, New York, and assistant professor of dermatology at Columbia University.

"Using wavelengths in the near infrared range, we are at a lower point on the melanin absorption curve and therefore are compromising some efficacy, but this is the range that is considered safest for darker skin types," he noted.

A review found that the long-pulsed 1064-nm laser had the lowest incidence of adverse events in dark-skinned patients, followed by the long-pulsed 800-nm or 810-nm diode laser (J. Drugs Dermatol. 2007;6:40-6).

"For patients with type IV or V skin, the diode laser is appropriate, as long as you are using long pulse durations," he said, "but for the darker skin types, particularly type VI, the 1064-nm Nd:YAG laser is the best choice for safety reasons."

In one study, researchers used a 1064-nm laser with contact cooling to treat pseudofolliculitis barbae in 37 patients with skin types IV, V, and VI. They found that the highest fluences tolerated by the epidermis were 50 J/cm2 for skin type VI and 100 J/cm2 for skin types IV and V (J. Am. Acad. Dermatol. 2002;47:263-70).

In another study, researchers used a 1064-nm laser with contact cooling for hair removal in 36 patients with skin types I-VI (Dermatol. Surg. 2004;30:13-7). Patients underwent three consecutive treatments at 4- to 6-week intervals. For skin types V-VI, investigators used a 30-millisecond pulse duration and a fluence of 30-45 J/cm2 on the face and 35-50 J/cm2 on nonfacial sites. Six months post treatment, the mean facial hair reduction ranged from 41% to 46%, while the mean hair reduction on the body ranged from 48% to 53%.

Based on the results of these and other studies, and from his own clinical experience, Dr. Alexis recommends a pulse duration of 100 milliseconds or 400 milliseconds when using a 810-nm diode laser and a duration of 20-30 milliseconds when using a 1064-nm Nd:YAG laser with contact cooling.

One recent study used a 1064-nm Nd:YAG laser with lower than traditional fluences for treating 22 patients with skin types IV-VI who had pseudofolliculitis barbae (Dermatol. Surg. 2009;35:98-107). Patients underwent five weekly treatments on the neck with a fluence of 12 J/cm2 and a pulse duration of 20 milliseconds and a spot size of 10 mm. At 4 weeks follow-up, the papule count had been reduced by a mean of 91% and dyspigmentation by a mean of 60%.

In another recent development, researchers studying a novel diode laser with a fluence of 5-10 J/cm2 used at a repetition rate of 10 Hz found that it resulted in less pain, faster treatment, and fewer adverse events compared with one pass of a high-fluence diode laser at 25-40 J/cm2 in Fitzpatrick skin types I-V (J. Drugs Dermatol. 2009;8:s14-7).

Options for epidermal cooling include cold gel, contact cryogen or forced air, and post treatment with ice packs for 10-15 minutes. Devices for contact cooling feature either a sapphire tip or chilled copper plate. Regardless of which type of contact cooling chosen, Dr. Alexis suggested "using a slower treatment speed in order to ensure adequate cooling before delivering pulse."

Dr. Alexis said that he had no relevant financial conflicts.

PHOENIX - When performing laser hair removal in patients with Fitzpatrick skin types IV-VI, keep in mind that darker skin contains more melanin in the epidermis, which acts as a competing chromophore, "so the risk for epidermal injury is higher," Dr. Andrew F. Alexis said.

Other tips to remember when treating this patient population include the melanocytes' tendency "to be labile in response to injury and inflammation, so there is an increased risk of dyschromia," Dr. Alexis said at the annual meeting of the American Society for Laser Medicine and Surgery. "This can manifest as hyperpigmentation or hypopigmentation following laser hair removal procedures."

He went on to note that fibroblasts in the dermis "are also more reactive to injury, so there is an increased risk of hypertrophic scars and keloids when performing surgical or some cosmetic procedures. In addition, having curved follicles [which are primarily seen in people of African descent] is associated with an increased prevalence of a number of follicular disorders."

His guidelines for performing laser hair removal safely on skin of color include longer wavelengths, lower fluences, longer pulse durations, and increased epidermal cooling.

"You want longer wavelengths because we're trying to maximize the ratio of follicular bulb temperature to epidermal temperature," explained Dr. Alexis, director of the Skin of Color Center at St. Luke's & Roosevelt Hospitals, New York, and assistant professor of dermatology at Columbia University.

"Using wavelengths in the near infrared range, we are at a lower point on the melanin absorption curve and therefore are compromising some efficacy, but this is the range that is considered safest for darker skin types," he noted.

A review found that the long-pulsed 1064-nm laser had the lowest incidence of adverse events in dark-skinned patients, followed by the long-pulsed 800-nm or 810-nm diode laser (J. Drugs Dermatol. 2007;6:40-6).

"For patients with type IV or V skin, the diode laser is appropriate, as long as you are using long pulse durations," he said, "but for the darker skin types, particularly type VI, the 1064-nm Nd:YAG laser is the best choice for safety reasons."

In one study, researchers used a 1064-nm laser with contact cooling to treat pseudofolliculitis barbae in 37 patients with skin types IV, V, and VI. They found that the highest fluences tolerated by the epidermis were 50 J/cm2 for skin type VI and 100 J/cm2 for skin types IV and V (J. Am. Acad. Dermatol. 2002;47:263-70).

In another study, researchers used a 1064-nm laser with contact cooling for hair removal in 36 patients with skin types I-VI (Dermatol. Surg. 2004;30:13-7). Patients underwent three consecutive treatments at 4- to 6-week intervals. For skin types V-VI, investigators used a 30-millisecond pulse duration and a fluence of 30-45 J/cm2 on the face and 35-50 J/cm2 on nonfacial sites. Six months post treatment, the mean facial hair reduction ranged from 41% to 46%, while the mean hair reduction on the body ranged from 48% to 53%.

Based on the results of these and other studies, and from his own clinical experience, Dr. Alexis recommends a pulse duration of 100 milliseconds or 400 milliseconds when using a 810-nm diode laser and a duration of 20-30 milliseconds when using a 1064-nm Nd:YAG laser with contact cooling.

One recent study used a 1064-nm Nd:YAG laser with lower than traditional fluences for treating 22 patients with skin types IV-VI who had pseudofolliculitis barbae (Dermatol. Surg. 2009;35:98-107). Patients underwent five weekly treatments on the neck with a fluence of 12 J/cm2 and a pulse duration of 20 milliseconds and a spot size of 10 mm. At 4 weeks follow-up, the papule count had been reduced by a mean of 91% and dyspigmentation by a mean of 60%.

In another recent development, researchers studying a novel diode laser with a fluence of 5-10 J/cm2 used at a repetition rate of 10 Hz found that it resulted in less pain, faster treatment, and fewer adverse events compared with one pass of a high-fluence diode laser at 25-40 J/cm2 in Fitzpatrick skin types I-V (J. Drugs Dermatol. 2009;8:s14-7).

Options for epidermal cooling include cold gel, contact cryogen or forced air, and post treatment with ice packs for 10-15 minutes. Devices for contact cooling feature either a sapphire tip or chilled copper plate. Regardless of which type of contact cooling chosen, Dr. Alexis suggested "using a slower treatment speed in order to ensure adequate cooling before delivering pulse."

Dr. Alexis said that he had no relevant financial conflicts.