Hypertricosis Not Uncommon After Laser Removal of Facial Hair
GRAPEVINE, TEX. Facial-hair removal with laser energy can backfire and trigger hypertrichosis if the regimen is not optimized, Dr. Andrea Willey said at the annual meeting of the American Society for Laser Medicine and Surgery.
In a review of more than 500 women who underwent photoepilation, it was found that paradoxical hair stimulation occurred in about 10%, much more common than previously reported.
A reliable way to prevent this outcome is to cool the surrounding skin with ice packs during laser treatment, along with using the maximum tolerated laser fluence and employing a double-pass technique, said Dr. Willey, who is a dermatologist at Oregon Health and Science University, Portland.
She and her associates reviewed before and after photos of 543 women who were treated for facial hair at a laser center in Spain from December 1998 to December 2003. The women were aged 1652 years; 68% had type III skin, and the remaining women had either type II or type IV skin.
About 80% were treated with an alexandrite laser, whereas the others were treated with either an Nd:YAG laser or intense pulsed light. They received 323 treatments.
At follow-up, an average of 10% of the women had increased facial hair, 8% had no change, 78% had reduced hair growth, and 3% had complete hair removal. The remaining 1% had incomplete information and weren't included in the analysis.
Women with hypertrichosis after treatment had the extra hair predominantly in their beard area. All of the affected women had prominent vellus hair before treatment, noted Dr. Willey.
No apparent link between skin type and hair growth was found. Of the 57 women with hair growth, 16 had polycystic ovary syndrome or irregular menses.
The cause of paradoxical hypertrichosis in this setting is not clear, and several mechanisms probably play a role, she said.
One possibility is that subtherapeutic laser energy injures hair follicles, thus stimulating growth rather than killing the follicles. To prevent this, dermatologists in Spain began to use ice packs, high fluence, and a double-pass technique.
Since this method started in late 2003, there have been no additional cases of paradoxical hypertrichosis in any patients treated with this approach, Dr. Willey said.
Several dermatologists who heard the report at the meeting said that their own anecdotal experience confirmed Dr. Willey's report.
"You can predict which women will have this. They all have fine, almost downy hair on dark skin that is type III or higher," said Dr. Jeffrey S. Dover, a dermatologist in private practice in Chestnut Hill, Mass.
"I don't treat thin, wispy hairs on the neck because the likelihood of hypertrichosis is so high," added Dr. E. Victor Ross, director of the laser and cosmetic dermatology unit at Scripps Clinic in San Diego.
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